Mortality  Statistics 

of  Insured  Wage-Earners  and 

Their  Families 


THE  LIBRARY 

OF 

THE  UNIVERSITY 
OF  CALIFORNIA 

LOS  ANGELES 


GIFT 

Dr.   Smil  3ogen 


V 

MORTALITY  STATISTICS 

OF  INSURED  WAGE-EARNERS  AND 

THEIR  FAMILIES 


EXPERIENCE  OF  THE  METROPOLITAN    LIFE    INSURANCE    COMPANY 
INDUSTRIAL    DEPARTMENT,    1911   TO    1916,   IN  THE 
UNITED  STATES  AND  CANADA     »  « 


BY 

LOUIS  I.  DUBLIN,  PH.D. 

STATISTICIAN 
WITH  THE   COLLABORATION  OP 

EDWIN  W.  KOPF 

ASSISTANT   8TATI8TICAN 
AND 

GEORGE  H.  VAN  BUREN 

6UPERVI80B,    STATISTICAL    BUREAU 


NEW  YORK 

METROPOLITAN  LIFE  INSURANCE  COMPANY 
1919 


To 

HALEY  FISKK,  ESQ. 

PRESIDENT 
METROPOLITAN  LIFE  INSURANCE  COMPANY 

whose  broad  vision  of  the  aims  and 
purposes  of  Industrial  Insurance 
inspired  the  produc- 
tion of  this 
work. 


PEEFACE. 

It  has  been  one  of  the  major  activities  of  the  Statistical  Bureau 
of  the  Metropolitan  Life  Insurance  Company  to  compile  the  medical 
statistics  of  mortality  among  policyholders  of  the  Industrial  De- 
partment. After  seven  years'  work,  data  are  available  in  consider- 
able detail  for  the  many  millions  of  policyholders  who  constitute 
its  membership.  In  fact,  nearly  fifty  million  years  of  life  and 
more  than  635,000  deaths  are  represented  in  the  period  1911  to 
1916  covered  in  this  report.  The  volume  is  an  analysis  of  this 
material  and  is  submitted  as  a  contribution  by  the  Company  to  the 
public  health  movement  in  the  United  States  and  Canada. 

Facts  herein  compiled  have  already  had  wide  public  uses.  From 
time  to  time,  reports  have  been  issued  in  scientific  and  medical 
journals  on  various  diseases  and  conditions.  A  large  part  of  the 
whole  field  of  mortality  statistics  has  been  considered  and  a  mass  of 
important  scientific  information  has  been  put  into  circulation. 
The  completeness  and  accuracy  of  the  data  have  commended  the 
studies  to  physicians  and  others  who  are  guided  in  their  work  by 
medical  statistics. 

The  present  volume  is,  however,  more  than  a  compilation  of  the 
papers  and  reports  which  have  appeared  in  recent  years.  The 
previous  discussions  have  been  much  amplified  and  much  new  in- 
formation has  been  added.  The  report  is,  in  fact,  a  comprehensive 
treatment  of  the  entire  field  of  mortality  as  related  to  wage  earners 
and  their  families. 

This  work  should  serve  as  a  supplement  to  general  population 
mortality  statistics  as  published  by  the  Bureau  of  the  Census  and 
by  the  several  State  and  municipal  registration  offices.  Large  areas 
of  the  country  still  outside  the  Eegistration  Area  of  the  United 
States  are  included  in  the  insurance  field  and  for  these  sections 
there  are  as  yet  no  authentic  compilations  of  mortality  statistics. 
This  report  also  contrasts  the  mortality  experience  of  wage  earners 
and  of  the  general  population.  The  medical  profession  especially 
will  profit  from  the  study  of  the  individual  diseases  with  their  de- 
tail of  death  rates  by  color,  sex  and  age  period.  In  some  cases,  the 
figures  will  suggest  new  lines  of  medical  research. 


iv  PREFACE. 

It  is  appropriate  that  the  insurance  companies  should  contribute 
to  the  advance  of  medical  science  and  to  the  public  health  move- 
ment. The  extensive  health  work  carried  on  by  the  Metropolitan 
demands  that  a  specific  answer  be  given  to  the  many  persons  who 
are  interested  to  know  what  the  effect  of  the  life  conservation  pro- 
gramme has  been  on  the  mortality  experience  of  policyholders. 
Health  and  social  workers  all  over  the  country  are  awaiting  a 
report,  showing  the  extent  of  the  mortality  saving  among  insured 
lives  and  the  diseases  and  conditions  which  have  been  most  affected. 

In  presenting  this  volume  to  the  public,  the  author  desires  to 
acknowledge  how  completely  this  and  other  scientific  contributions 
from  the  Statistical  Bureau  are  the  result  of  the  continued  co- 
operation and  encouragement  of  the  executives  of  the  Company. 
To  Dr.  Lee  K.  Frankel,  Third  Vice  President,  his  obligation  is 
especially  great  for  the  many  suggestions  concerning  the  develop- 
ment of  the  Bureau's  work.  It  is  appropriate  also  that  proper 
acknowledgment  be  made  to  the  medical  profession  of  the  United 
States  and  Canada.  About  thirty-five  thousand  letters  from 
thousands  of  physicians  have  materially  helped  to  complete  and 
clarify  the  medical  data  in  obscure  cases.  Finally,  it  is  a  pleasure 
to  acknowledge  the  loyal  and  effective  assistance  received  through- 
out the  progress  of  this  work  from  Mr.  Edwin  W.  Kopf,  Assistant 
Statistician,  and  from  Mr.  George  H.  Van  Buren,  Supervisor,  both 
of  whom  I  am  honored  to  have  associated  with  me  in  this  publi- 
cation. 

Louis  I.  DUBLIN. 

Sept.  12,  1918. 


CONTENTS 

PAGE 

PREFACE iii-iv 

CHAPTER  I — Introductory    1-10 

Uses  of  Industrial  Insurance  Medical  Statistics — Scope  of 
the  Present  Statistics  with  respect  to  Area,  Occupation,  and 
Color,  Sex  and  Age — Technical  Processes  of  Compiling  the 
Statistics. 

CHAPTER  II — Mortality  from  All  Causes  of  Death  Com- 
bined        11-29 

Deaths  and  Death  Kates  according  to  Color,  Sex  and  Age — 
Death  Rates  of  White  Persons  in  Insurance  Experience  Com- 
pared with  Death  Rates  in  Expanding  Registration  Area  of 
the  United  States,  by  Sex  and  by  Age  Period — Factors  Influ- 
encing Industrial  Insurance  Mortality — Downward  Trend  of 
Mortality  among  Insured  Wage  Earners. 

CHAPTER  III — Mortality  from  Principal  Causes  of  Death       30-42 
Sources  of  Data — Improving  Accuracy  of  Certified  Causes  of 
Death  of  Wage  Earners — Nomenclature  and  Classification  of 
Diseases. 

CHAPTER  IV — Tuberculosis    43-64 

Mortality  according  to  Organs  or  Parts  Affected — Mortality 
from  Tuberculosis  of  the  Lungs  according  to  Color,  Sex  and 
Age  Period — Types  of  Pulmonary  Tuberculosis  Mortality 
among  Wage  Earners — Mortality  among  Insured  Wage 
Earners  and  Population  of  Expanding  Registration  Area 
Compared — Trend  of  Tuberculosis  Mortality — Tuberculous 
Meningitis — Abdominal  Tuberculosis — Tuberculosis  of  Other 
Organs. 

CHAPTER  V — Organic  Diseases  of  the  Heart 65-71 

Heart  Disease  Mortality  according  to  Color,  Sex  and  Age 
Period — Mortality  among  Insured  Wage  Earners  and  among 
Population  of  Expanding  Registration  Area — Trend  of  the 
Death  Rate — Certification  of  Diseases  of  the  Heart. 


CHAPTER  VI — Pneumonia    

a.  Pneumonia  (Lobar  and  Undefined) : 

Mortality  from  Pneumonia  according  to  Color,  Sex  and 
Age — Pneumonia  as  a  Cause  of  Death  among  Wage 
Earners  and  among  General  Population  of  Expanding 


72-86 


VI  CONTENTS. 

PAOt 

Registration  Area  Compared — Effect  upon  Pneumonia 
Mortality  Statistics  of  Improvement  in  Certification 
of  Causes  of  Death. 

b.  Broni-hopneumonia: 

Mortality  from  Bronchopneumonia  according  to  Color, 
Sex  and  Age — Trend  of  Bronchopneumonia  Mortality — 
Bronchopneumonia  among  Insured  Wage  Earners  and 
among  Population  of  Expanding  Registration  Area  Com- 
pared— Reliability  of  Mortality  Statistics  of  Broncho- 
pneumonia. 

CHAPTER  VII— Bright's  Disease  87-92 

Complications  of  Bright 's  Disease  with  Cardiovascular  Dis- 
eases— Bright 's  Disease  Mortality  according  to  Color,  Sex 
and  Age  Period — Bright 's  Disease  among  Insured  Wage 
Earners  and  among  General  Population  of  Expanding  Regis- 
tration Area  Compared — Trend  of  the  Death  Rate. 

CHAPTER  VIII — External   Causes  of  Death    (Accident, 

Suicide  and  Homicide)    95-146 

a.  Accidents,  including  Unspecified  Violence: 

Accident  Death  Rate  according  to  Color,  Sex  and  Age 
Period — Fatal  Accidents  among  Insured  Wage  Earners 
and  among  Population  of  Expanding  Registration  Area 
Compared — Fatal  Accidents  according  to  Specific  Means 
or  Nature  of  Injury:  Traumatism  by  Fall — Accidental 
Drowning — Burns  (Conflagration  Excepted) — Steam 
Railroad  Accidents  and  Injuries — Automobile  Accidents 
and  Injuries — Street  Car  Accidents  and  Injuries — In- 
juries by  Other  Vehicles — Traumatism  by  Machines — 
Acute  Accidental  Poisonings — Absorption  of  Deleterious 
Gases — Traumatism  by  Firearms — Industrial  Fatal  Acci- 
dents— Trend  of  the  Accident  Death  Rate. 

6.  Suicides: 

Suicide  Mortality  according  to  Color,  Sex  and  Age 
Period — Suicide  Death  Rate  among  Insured  Wage  Earn- 
ers and  Population  of  Expanding  Registration  Area 
Compared — Suicide  according  to  Principal  Means  of 
Injury:  Suicide  by  Poison — Suicide  by  Asphyxia — Sui- 
cide by  Hanging  or  Strangulation — Suicide  by  Drown- 
ing— Suicide  by  Firearms. 

c.  Homicides: 

Homicide,  all  Forms  of  Injury,  by  Color,  Sex  and  Age 
Period — Homicide  Mortality  among  Insured  Wage  Earn- 
ers and  among  General  Population  of  Expanding  Regis- 
tration Area — Trend  of  the  Homicide  Death  Rate. 


CONTENTS.  Vii 

PAGE 

CHAPTEE  IX— Cancer   • 147-172 

Certification  of  Cancer  as  a  Cause  of  Death — Cancer  Mortal- 
ity according  to  Organs  or  Parts  Affected — Cancer  Mortality 
according  to  Color,  Sex  and  Age  Period — Cancer  among  In- 
sured Wage  Earners  and  among  Population  of  Expanding  . 
Registration  Area  of  United  States  Compared — Relation  of 
Cancer  to  Economic  Condition — Trend  of  the  Cancer  Death 
Rate — Detailed  Mortality  Statistics  of  Cancer  according  to 
Organs  or  Parts:  Cancer  of  the  Stomach  and  Liver — Cancer 
of  the  Female  Genital  Organs — Cancer  of  the  Breast — Can- 
cer of  the  Peritoneum,  Intestines  and  Rectum — Cancer  of  the 
Buccal  Cavity — Cancer  of  the  Skin — Cancer  of  Other  Organs 
or  of  Organs  not  Specified. 

CHAPTER  X — Cerebral  Hemorrhage  and  Apoplexy 173-177 

Certification  of  Cerebral  Hemorrhage  and  Apoplexy  as  a 
Cause  of  Death — Mortality  according  to  Color,  Sex  and  Age 
Period — Cerebral  Hemorrhage  among  Insured  Wage  Earners 
and  among  Population  of  Expanding  Registration  Area  Com- 
pared— Trend  of  the  Death  Rate. 

CHAPTER  XI — Four  Principal  Communicable  Diseases  of 

Childhood    178-192 

Measles,  Scarlet  Fever,  Whooping  'Cough,  Diphtheria  and 
Croup. 

CHAPTER  XII— Diarrhea  and  Enteritis  193-196 

Diarrhea  and  Enteritis  as  Primary  and  Secondary  Causes 
of  Death — Mortality  according  to  Color,  Sex  and  Age 
Period — Diarrhea  and  Enteritis  Mortality  among  Insured 
Wage  Earners  and  among  General  Population  of  Expanding 
Registration  Area — Trend  of  the  Death  Rate  from  Diarrhea 
and  Enteritis. 

CHAPTER  XIII — Diseases  and  Conditions  Incidental  to 

the  Maternal  State 197-214 

Methods  of  Studying  Maternal  Mortality — Color  and  Age 
Incidence  of  Principal  Causes  of  Maternal  Mortality:  All 
Puerperal  Diseases  and  Conditions  Combined — Puerperal 
Septicemia — Puerperal  Albuminuria  and  Convulsions — Acci- 
dents of  Pregnancy — Puerperal  Hemorrhage — "Other  Acci- 
dents of  Labor" — Maternal  Mortality  among  Insured  Fe- 
males and  among  Population  of  the  Expanding  Registration 
Area  Compared:  All  Puerperal  Diseases  and  Conditions — 
Puerperal  Septicemia  and  Puerperal  Albuminuria  by  Age. 

CHAPTER  XIV — Diseases  of  the  Arteries ;  Typhoid  Fever ; 

Cirrhosis  of  the  Liver;  Influenza;  Diabetes 215-232 


Viii  CONTENTS. 

PAGl 

CHAPTER  XV— Appendicitis ;  Hernia,  Intestinal  Ob- 
struction; Syphilis;  Chronic  Bronchitis;  Rheu- 
matism; Acute  Bronchitis;  Alcoholism,  Acute 
and  Chronic  233-248 

CHAPTER  XVI — Pellagra;    Malaria;    Angina    Pectoris; 

Ulcer  of  Stomach ;  Acute  Poliomyelitis 249-263 

CHAPTER  XVII — Miscellaneous  Diseases  and  Conditions  264-290 
Dysentery1— Erysipelas — Purulent  Infection  and  Septicemia 
— Gonoeoccus  Infection — Anemia,  Chlorosis — ' '  Other  Chronic 
Poisonings"  —  Encephalitis  —  Meningitis  —  Cerebrospinal 
Fever — Locomotor  Ataxia — Softening  of  the  Brain — General 
Paralysis  of  the  Insane — Convulsions — "  Other  Diseases  of 
the  Nervous  System" — Diseases  of  the  Ears — Pericarditis — 
Acute  Endocarditis — Embolism  and  Thrombosis — Diseases 
of  the  Larynx — Pulmonary  Congestion,  Pulmonary  Apo- 
plexy— Asthma — "  Other  Diseases  of  the  Eespiratory  Sys- 
tem"— -Diseases  of  the  Pharynx — "  Other  Diseases  of  the 
Stomach  (Cancer  Excepted)  " — .Biliary  Calculi — "Other 
Diseases  of  the  Liver" — Simple  Peritonitis  (Nonpuerperal) — 
Acute  Nephritis — "Other  Diseases  of  the  Kidneys" — Dis- 
eases of  the  Bladder — Diseases  of  the  Prostate — Uterine 
Tumor  (Noncancerous) — "Other  Diseases  of  the  Uterus" — 
Salpingitis,  Other  Diseases  of  the  Female  Genital  Organs — 
Gangrene — Old  Age — Ill-Defined  Diseases. 

SUPPLEMENT  293-302 

Mortality  Statistics  of  Insured  Wage  Earners,  1917. 

APPENDIX  A  304-365 

Table  Showing  Number  of  Deaths  from  each  Specified  Dis- 
ease or  Condition.  Classified  by  Color,  Sex,  and  by  Age 
Groups.  Period  1911  to  1916. 

APPENDIX  B   366-376 

Table  Showing  Number  of  Deaths  from  each  Specified  Dis- 
ease or  Condition,  and  Death  Rates  per  100,000  Exposed, 
for  the  Period  1911  to  1916,  and  for  each  Calendar  Year. 

APPENDIX  C    377-384 

Effect  of  System  of  Inquiry  to  Physicians  upon  Death  Rates 
of  Principal  Diseases  and  Conditions;  with  Tables. 

A  iM-KNDix  D   385-387 

Standardized,  or  Corrected  Death  Rates.  Metropolitan  In- 
dustrial and  United  States  Registration  Area  Death  Rates, 
all  Causes,  Corrected  on  Basis  of  Standard  Million  of  Popu- 
lation of  England  and  Wales,  1901. 

INDEX 389  et  seq. 


MORTALITY  STATISTICS  OF  INSURED 
WAGE  EARNERS  AND  THEIR  FAMI- 
LIES IN  THE  UNITED  STATES 
AND  CANADA. 


CHAPTER  I. 

INTRODUCTORY. 
Public  Health  and  Social  Data  of  the  Industrial  Population. 

This  report  is  presented  as  a  contribution  to  the  facts  on  the 
vitality  of  American  wage  earners.  The  great  Metropolitan  family 
of  ten  million  policyholders  is,  more  than  any  group  for  whom  data 
are  available,  typical  of  our  industrial  population.  The  policy- 
holders  are  bound  together  by  many  ties  which  justify  and  add  in- 
terest to  a  presentation  of  the  facts  of  their  mortality.  This  report 
is  intended,  however,  to  be  more  than  a  compilation  of  death  rates. 
It  is  hoped  that  it  will  serve  as  a  contribution  to  the  public  health 
and  social  welfare  movements  of  recent  years.  The  six  year  period 
covered  by  the  report,  1911  to  1916  inclusive,  is  coincident  with  the 
period  during  which  a  wide  programme  of  life  conservation  has  been 
developed  by  the  Company  for  its  policyholders.  Education  in 
personal  and  civic  hygiene,  the  care  of  the  sick  by  visiting  nurses 
and  a  number  of  other  activities  have  been  put  into  operation  to 
improve  the  health  of  this  large  body  of  insured  men,  women  and 
children.  The  facts  which  will  be  presented  should,  therefore,  show 
what  has  been  achieved  through  this  programme  and  what  still 
remains  to  be  done  in  checking  preventable  sickness  and  premature 
death.  Experience  has  proved  that  the  ever  broadening  movement 
for  life  conservation  must  rest  upon  a  firm  foundation  of  well 
established  facts. 

Area  Covered  by  These  Data. 

These  data  are  of  interest  and  value  to  public  health  and  social 
workers  because  they  are  comprehensive.     They  relate  to  an  area 
2  1 


2  MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

which  includes  nearly  all  the  states  of  the  United  States  and  the 
provinces  of  Canada.  The  statistics,  therefore,  reflect  the  sanitary 
and  social  conditions  prevailing  throughout  the  industrial  popula- 
tion of  two  great  national  units.  The  only  states  not  included  in 
this  experience  are  Mississippi,  North  and  South  Dakota,  Wyom- 
ing, Colorado,  Texas,  Nevada,  Arizona  and  New  Mexico.  It  should 
be  remembered  that  even  in  these  states  reside  a  considerable  num- 
ber of  policyholders  who  transact  their  business  by  correspondence 
with  the  Home  Office  of  the  Company  in  New  York  City.  It  may 
be  said,  therefore,  that  the  figures  are  truly  representative  of  the 
entire  wage  earning  population  of  the  United  States  and  Canada. 
The  geographic  range  of  the  data  is  much  broader  than  that  of  the 
Registration  Area  established  by  the  United  States  Bureau  of  the 
Census  for  the  collection  of  mortality  statistics  of  the  general  popu- 
lation of  the  United  States.  A  large  proportion  of  the  insured 
wage  earners  reside  in  the  so-called  non-registration  area  and  the 
facts  for  them  will  be  included  in  our  compilation.  The  im- 
portance of  this  will  be  brought  out  in  some  detail  in  the  discussion 
of  some  diseases  and  conditions  whose  incidence  is  confined  very 
largely  to  certain  sections  of  the  country  where  state-wide  registra- 
tion of  mortality  does  not  as  yet  exist.  In  fact,  the  data  for  insured 
wage  earners  presented  herein  will  for  some  time  remain  the  only 
authentic  compilation  of  mortality  for  these  areas. 

Wide  Range  of  Occupations  among  Insured  Wage  Earners. 
The  facts  presented  in  this  report  are  unique  also  because  they 
present  for  the  first  time  a  connected  and  detailed  analysis  of  the 
facts  of  mortality  among  the  industrial  workers  of  the  country. 
All  the  important  industries  and  occupations  are  represented. 
Laborers  form  the  largest  single  group,  followed  by  teamsters, 
drivers  and  chauffeurs,  by  machinists,  by  textile  mill  operatives,  by 
clerks  and  office  assistants  in  the  order  named.  In  fact,  all  the 
more  skilled  industrial  workers  are  represented,  and  in  a  proportion 
not  very  different  from  that  found  among  occupied  persons  in  the 
general  population.  The  diversity  of  occupations  among  white 
males  in  this  mortality  experience  will  be  seen  by  referring  to 
page  87,  of  Bulletin  207,  United  States  Bureau  of  Labor  Statistics, 
March,  1917.  This  document  displays  the  occupational  mortality 
experience  of  the  Industrial  Department  of  this  Company,  accord- 
ing to  principal  causes  of  death. 


INTEODUCTOET.  3 

Women  and  Children  in  Wage  Earners'  Families. 

The  members  of  wage  earners'  families  are  also  accounted  for  in 
good  measure  in  this  collection  of  data.  A  very  large  proportion  of 
the  total  number  of  persons  observed  are  the  wives  and  children  of 
wage  workers.  In  this  respect,  it  is  believed  that  this  study  pre- 
sents for  the  first  time  a  discussion  of  the  facts  of  mortality  among 
women  and  children  of  the  wage  earning  groups  of  the  American 
population.  We  shall  see  later  in  our  discussion  of  the  age  char- 
acteristics of  this  group  of  insured  persons  that  a  fairly  close  corre- 
spondence with  the  age  distribution  of  the  general  population  is 
maintained  for  a  considerable  span  of  life. 

Although  all  the  statistics  which  follow  include  the  women  and 
children  in  wage  earners'  families,  reference  is  usually  made  to  the 
group  as  that  of  insured  wage  earners,  the  full  title  being  thus 
abbreviated  for  simplicity. 

Mortality  Data  of  the  White  and  Colored  Races. 

The  facts  also  display  the  mortality  characteristics  of  both  the 
white  and  colored  races  among  the  insured  wage  earning  popula- 
tion. These  facts  of  comparative  mortality,  considered  according 
to  sex  and  age,  are  practically  unavailable  in  any  official  vital  sta- 
tistics for  the  general  population.  Such  comparisons  between  the 
mortality  of  the  white  and  colored  races  as  do  exist  have  been  based 
upon  figures  which  included  all  classes  of  the  white  population  on 
the  one  hand  and  all  classes  of  the  colored  population  on  the  other. 
For  purposes  of  determining  race  characteristics  of  mortality,  these 
comparisons  are  invalid  because  of  the  sharply  different  environ- 
mental circumstances  of  the  groups.  The  colored  race  in  the  United 
States,  especially  in  urban  centers  of  population,  suffers  sanitary 
and  other  social  disabilities  which  must  be  discounted  before  fair 
comparisons  of  colored  with  white  mortality  can  be  made.  When 
the  statistics  of  white  and  colored  wage  earners  are  compared,  how- 
ever, much  of  the  objection  to  the  usual  figures  for  white  and 
colored  mortality  is  removed.  The  insurance  data  have  the  further 
advantage  that  the  number  of  colored  persons  is  large,  covering  all 
urban  areas  in  the  North  as  well  as  in  the  South.  The  data  are 
also  representative  of  both  sexes  and  of  all  ages  of  colored  persons 
exclusive  of  infants. 


MORTALITY    STATISTICS  OF    INSURED   WAGE  EARNERS. 


Number  and  Composition  of  the  Insured  Group  as  to  Color,  Sex 

and  Age. 

This  widely  distributed  and  representative  group  of  wage  earners 
contributed  very  nearly  54,000,000  years  of  life  for  observation  in 
the  mortality  experience  of  the  period  1911  to  1016.  Of  this  num- 
ber, more  than  47,000,000  years  of  life,  or  87.5%,  pertained  to 
white  policyholders  and  nearly  6.700,000,  or  12.5%,  to  colored  pol- 
irvholders.  It  is  evident  that  thorp  was  a  sufficient  number  of 
lives  exposed  in  this  inquiry  to  warrant  drawing  reliable  conclu- 
sions. This  mass  of  data,  considered  in  relation  to  its  wide  geo- 
graphic distribution,  its  special  application  to  the  wage  earning 
group  of  the  population,  its  substantial  characteristics  as  to  color, 
sex  and  age  classes,  and  the  completeness  of  the  registration  of  the 
facts  is,  in  our  opinion,  unparalleled  in  the  history  of  American 
vital  statistics. 

The  following  table  gives  the  color  and  sex  characteristics  of  the 
data: 

TABLE  1. 
NUMBER  AND  PERCENTAGE  OP  POLICYHOLDERS^   1911  TO  1916.    CLASSIFIED 

BY  COLOR  AND  BY  SEX. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Color  and  Sex. 

Number. 

Percentage. 

Total  

53,796,547* 

100.0 

White  

47,098,458 

87.5 

Male  

21,389,717 

39.8 

Female  

25,708,741 

47.8 

Colored  

6,698,089 

12.5 

Male  

3,051,956 

5.7 

Female  

3,646,133 

68 

*  Strictly  speaking  these  represent  years  of  life  exposed  during  the  six 
year  period  and  not  so  many  different  persons.  The  method  employed  to 
obtain  this  figure  from  the  number  of  policies  in  force  will  be  explained 
on  page  8. 

Very  nearly  one-half  of  the  total,  (47.8  per  cent.)  were  white 
females.  The  proportions  of  the  white  and  the  colored,  respectively, 
in  this  group  of  policyholders,  are  different  from  those  found  in 
the  general  population  of  the  Registration  Area  for  deaths  in  the 


INTRODUCTORY. 


United  States.  The  proportion  of  negroes  represented  in  this  in- 
vestigation is  nearly  three  times  that  found  in  the  expanding  Reg- 
istration Area  of  the  United  States.  For  the  latter  area,  over  the 
period  1910  to  1915,  4.6  per  cent,  of  the  total  estimated  population 
was  of  negro  extraction.  This  variation  in  our  data  is  due  pri- 
marily to  the  choice  of  localities  in  which  the  Company  conducts 
industrial  life  insurance  business.  It  has  been  thought  desirable, 
therefore,  to  confine  our  comparisons  in  the  later  sections  of  this 
report  to  specific  race,  sex  and  age  classes  and  not  to  discuss  to 
any  great  extent  the  aggregate  results  of  both  white  and  colored 
mortality  experiences. 

Age  Constitution  of  the  Insurance  Experience. 

The  age  composition  of  the  group  of  policyholders  observed  in 
this  mortality  investigation  is  also  of  interest,  especially  when  it  is 
desired  to  make  comparison  of  our  data  with  those  for  the  general 
population.  In  the  following  table  we  present  a  comparison  of  the 


TABLE  2. 

PERCENTAGE    DISTRIBUTION*    OF    ESTIMATED    NUMBER    OF 
CLASSIFIED  BY  AGE  PERIOD  FOR  EACH  SEX. 


POLICYHOLDEBS 


Metropolitan  Life  Insurance  Company,  Industrial  Department,  1911  to  1916, 

and  Estimated  Population  of  Expanding  Begistration  Area  of  the 

United  States,  1910  to  1915. 


Age  Period. 

Males. 

Females. 

M.  L.  I.  Co.. 
1911  to  1916. 

Reg.  Area, 
1910  to  1915. 

M.  L.  I.  Co., 
1911  to  1916. 

Reg.  Area, 
1910  to  1915. 

All  ages  —  one  and  over 
1  to  4  

100.00 

100.00 

100.00 

100.00 

9.35 
15.05 
13.62 
12.30 
10.14 
14.55 
10.18 
7.37 
4.95 
2.15 
.32 

8.30 
9.45 
9.05 
9.38 
10.12 
18.15 
14.49 
10.34 
6.07 
3.33 
1.33 

7.59 
12.27 
11.05 
10.43 
10.11 
16.72 
12.80 
9.53 
6.29 
2.78 
.44 

8.57 
9.82 
9.45 
9.98 
10.27 
17.33 
13.81 
9.72 
5.96 
3.53 
1.57 

5  to  9  

10  to  14  

15  to  19  

20  to  24      

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74    . 

75  and  over  .... 

percentage  of  policyholders  and  of  estimated  population  in  the 
several  age  classes.  The  matter  of  color  distinction  is  not  of  basic 
importance  in  this  discussion  of  age  distribution  and  the  data  are 


MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


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INTRODUCTORY.  7 

accordingly  presented,  in  this  particular  instance,  by  sex  only,  for 
all  classes  of  insured  persons  combined  and  for  all  race  groups  of 
the  general  population  in  the  Registration  Area  of  the  United 
States. 

Comparisons  are  confined  to  ages  one  year  and  over  because  no 
children  under  one  year  of  age  are  included  in  the  insurance  ex- 
perience. In  the  foregoing  table  we  find  a  considerably  larger  bulk 
of  both  males  and  females  under  twenty  years  of  age  in  the  insur- 
ance experience  than  in  the  general  population  experience.  In  the 
population  group,  we  find  a  slightly  greater  representation  of  women 
at  the  child-bearing  ages  than  among  the  insured  females.  The 
main  working  period  of  life  contains  a  larger  representation  of 
males  of  the  general  population  than  of  males  in  the  insured  group. 

The  graph  on  page  6  shows  the  tendency  of  the  population  group 
to  bulk  more  heavily  in  the  later  ages  of  life.  Together  with  Table 
2,  it  emphasizes  the  necessity  for  considering  age  and  sex  distinc- 
tions in  analyzing  the  experience  of  the  two  groups.  Comparisons 
between  the  population  and  insurance  experience  can  be  made  with 
safety  only  when  the  higher  average  age  of  the  population  group  is 
discounted  by  confining  such  comparisons  strictly  to  similar  age 
and  sex  classes. 

Composition  with  Respect  to  Other  Factors. 
The  composition  of  the  group  of  policyholders  with  respect  to 
nativity,  parentage  and  other  factors  which  materially  affect  a  mor- 
tality experience,  is  also  different  for  this  group  of  insured  wage 
earners  than  for  the  general  population.  There  are  no  figures 
available  at  the  present  time  to  indicate  the  precise  proportions  of 
native  and  foreign  born  persons  nor  of  the  number  of  persons  of 
the  several  foreign  white  race  stocks  among  the  insured.  It  is  not 
possible,  therefore,  to  say  how  much  our  figures  are  affected  by  the 
single  factor  of  nationality  or  by  the  racial  mortality  characteristics 
of  the  foreign  white  stocks  in  our  experience.  It  should  be  borne 
in  mind  that  these  policyholders  reside  almost  altogether  in  cities 
and  towns  and  therefore  have  all  the  characteristics  of  an  urban 
population. 

Technical  Processes  of  Compiling  the  Data. 
The  foregoing  comment  has  described  briefly  the  broader  charac- 
teristics of  our  data — their  scope  and  application  to  the  study  of 


8  MORTALITY    STATISTICS   OF    INSURED    WAGE   EARNERS. 

the  public  health  problems  affecting  the  wage  earning  population. 
In  order  better  to  understand  the  exposition  of  the  detailed  data 
in  the  report,  it  will  be  well  to  view  in  summary  the  chief  tech- 
nical processes  employed. 

Estimating  the  Number  of  Policyholders  Exposed  to  Risk. 
The  registers  of  an  industrial  life  insurance  company  do  not 
show  the  number  of  separate  persons  exposed  to  risk.  The  ac- 
counts of  mortality  are  in  everyday  actuarial  practice  related  only 
to  the  policy  exposure.  Industrial  insurance  medical  statistics, 
however,  require  that  a  reliable  estimate  of  the  number  of  separate 
persons,  or  the  years  of  life  exposed,  be  prepared.  We  may  say 
briefly  that  this  estimate  of  the  number  of  years  of  life  exposed  to 
risk  according  to  the  several  color,  sex  and  age  classes  of  the  data 
was  prepared  on  the  assumption  that  the  ratio  in  each  of  these 
classes  of  the  number  of  claims  paid  to  the  number  of  decedents  in- 
volved in  these  claims  \vas  the  same  as  the  number  of  policies  out- 
standing to  the  number  of  lives  insured.  From  the  tabulation  of 
the  number  of  deaths  and  the  number  of  claims  according  to  color, 
sex  and  age  classes  these  ratios  were  prepared.  They  were  applied 
to  the  mean  numbers  of  policies  outstanding  in  each  of  the  calendar 
years  of  this  experience  and  the  number  of  years  of  life  exposed 
to  risk  was  thus  estimated  for  the  entire  six-year  experience. 

Classifying  and  Tabulating  the  Data  for  Deaths. 

The  preparation  of  the  data  from  the  primary  records  of  the 
claims  paid  in  the  Industrial  Department  involved  a  number  of 
technical  processes.  The  accuracy  and  planning  of  these  matters 
of  office  practice  have  an  important  bearing  upon  the  value  of  the 
conclusions  to  be  drawn  from  the  tabular  material  displayed  in  this 
report.  A  brief  discussion  of  these  processes  follows: 

All  of  the  necessary  records  in  connection  with  each  claim  were 
examined  and  the  items  which  it  was  desired  to  consider  in  the 
tabulation  of  the  statistics  were  abstracted  upon  so-called  "tran- 
script sheets,"  each  line  containing  the  necessary  information  for 
a  single  claim.  Some  of  the  facts,  such  as  age,  amount  of 
insurance  and  other  strictly  numerical  data,  were  directly  copied 
upon  the  line  corresponding  to  the  particular  claim  document. 
Other  items  such  as  the  disease  causing  death,  the  occupation,  place 
of  birth,  etc..  were  first  classified  in  terms  of  numerical  symbols 


INTRODUCTORY.  9 

and  then  copied  upon  the  transcript  sheets.  The  final  product  of 
this  transcribing  and  classification  process,  for  each  claim,  is  a 
single  line  of  numerical  symbols,  the  meaning  of  which  can  be  in- 
terpreted according  to  a  previously  arranged  coding  system.  Ages 
were  recorded  in  this  investigation  according  to  the  age  at  the 
nearest  birthday.  The  symbols  for  color  and  sex  of  the  deceased 
presented  no  problems  worthy  of  mention.  The  diseases  causing 
death  and  the  occupations  of  the  deceased,  however,  were  classified 
only  through  the  exercise  of  extreme  care  in  the  examination  of 
the  claim  papers  and  only  after  the  full  requirements  of  standard 
systems  of  nomenclature  and  classification  in  each  of  these  chief 
subjects  had  been  complied  with. 

Classification  of  Diseases  Causing  Death 

The  system  of  nomenclature  and  classification  employed  in  arriv- 
ing at  numerical  designations  for  use  in  this  analysis  of  wage 
earners'  mortality  experience  was  the  excellent  "  International  List 
of  Causes  of  Death."  The  requirements  of  this  well  known  and 
widely  accepted  system  of  preparing  statistical  data  of  diseases 
were  followed  out  in  every  important  respect.  Where  two  or  more 
diseases  or  conditions  were  reported  by  physicians  on  the  death 
certificate,  assignment  of  the  death  to  one  particular  disease  or 
condition  was  made  according  to  the  rules  laid  down  in  the  Classi- 
fication Manual  and  to  certain  general  rules  of  selective  classifica- 
tion .procedure  authorized  by  the  United  States  Bureau  of  the  Cen- 
sus, Division  of  Vital  Statistics. 

Classification  of  Occupations. 

Occupations  of  deceased  persons  were  recorded  generally  in  satis- 
factory detail  upon  the  Company's  forms  for  the  reporting*  of  deaths. 
This  permitted  us  to  compile  fairly  precise  information  on  the  oc- 
cupational aspects  of  this  mortality  experience.  The  occupations 
were  classified  in  accordance  with  the  rulings  of  the  "  Classified 
Index  to  Occupations"  issued  by  the  "United  States  Bureau  of  the 
Census  in  1910.  The  full  list  of  occupation  titles  given  in  this 
official  index  was  not  used.  The  list  of  titles  was  in  fact  limited 
to  a  certain  number  of  occupations  in  the  leading  industries  which 
were  of  interest  either  because  of  the  number  of  deaths  reported 
in  them  annually,  or  because  of  some  special  feature  of  hazard  or 
hygiene.  It  is  believed  that  much  time  and  unnecessary  work  were 


10  MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

thus  saved  in  the  tabulation  and  interpretation  of  the  material. 
No  detailed  occupation  data  are  given  in  this  report,  but  the  full 
account  of  the  mortality  experience  of  the  Industrial  Department 
of  this  Company  according  to  the  occupations  of  deceased  persons 
over  the  years  1911  to  1913  was  rendered  in  Bulletin  No.  207  of 
the  United  States  Bureau  of  Labor  Statistics  quoted  in  another 
section  of  this  report. 

Tabulating  the  Data  from  Perforated  Cards. 

The  material  of  this  study  was  tabulated  by  machine  processes 
which  necessitated  the  use  of  perforated  tabulating  cards.  It  is 
necessary  to  say  only  that  the  information  on  each  claim  was  trans- 
ferred from  the  transcript  sheets  mentioned  above  to  the  tabula- 
ting cards  by  means  of  Hollerith  Punching  Machines.  For  pur- 
poses of  accuracy  the  information  -on  each  claim  was  perforated  in 
duplicate,  first  upon  a  buff  card,  then  upon  a  red  card.  The  buff 
and  red  cards  for  each  claim  were  perforated  by  different  operators. 
The  buff  card  for  each  claim  was  checked  against  the  corresponding 
red  card  by  holding  both  cards  against  an  illuminated  glass  plate. 
When  discrepancies  were  revealed,  reference  to  the  line  on  the  tran- 
script sheet  covering  the  case  showed  which  card  was  correct.  This 
process  insured  the  accurate  transfer  of  the  facts  from  the  transcript 
sheets  to  the  tabulating  cards. 

The  first  process  in  the  tabulation  of  the  data  was  to  identify 
the  deaths  in  the  experience  separately  from  the  claims.  Often 
more  than  one  claim  was  reported  for  one  death ;  that  is,  in  cases 
where  the  insured  carried  a  number  of  policies  on  his  or  her  life. 
The  extra  or  secondary  claims  were  designated  by  a  distinguishing 
symbol  which  made  it  possible  to  sort  out  those  cards  which  corre- 
sponded to  deaths  only.  It  was  further  decided  to  confine  this  in- 
vestigation to  the  so-called  "  premium-paying  business  "  of  the  In- 
dustrial Department.  This  excluded  a  small  proportion  of  the  ex- 
perience on  the  lives  of  persons  who  were  insured  on  a  "  paid-up  "  or 
similar  basis.  The  reason  for  this  will  be  made  clearer  as  we  pro- 
ceed, but  at  this  point  it  may  be  said  that  sufficiently  detailed  in- 
formation with  regard  to  the  age,  sex  and  color  of  these  "  paid-up  " 
policyholders  is  not  at  hand.  On  the  other  hand,  information  with 
regard  to  the  living  premium-paying  policyholders  is  especially 
complete,  making  possible  the  most  detailed  comparisons  of  the 
living  and  of  the  deceased  policyholders. 


CHAPTEK  II. 


MORTALITY  FROM  ALL  CAUSES  OP  DEATH  COMBINED. 

In  this  section  we  shall  consider  in  some  detail  the  total  mortal- 
ity of  the  insured  group,  that  is,  without  distinction  of  the  indi- 
vidual causes  of  death.  We  shall  comment  also  upon  the  death 
rates  for  the  several  color,  sex  and  age  classes.  Later  we  shall  con- 
sider the  special  factors  which  we  believe  influence  more  or  less  the 
general  mortality  experience  of  those  insured  in  an  industrial  life 
insurance  company. 

Deaths  according  to  Color,  Sex  and  Age. 

A  total  of  635,449  deaths  is  represented  in  this  experience  for 
the  calendar  years  1911  to  1916  inclusive.  Of  this  number  520,079 
deaths  were  of  white  persons  and  115,370  were  deaths  of  colored 
persons.  The  following  table  gives  a  view  of  the  color  and  sex 
composition  of  the  deaths : 

TABLE  3. 
NUMBER  AND  PERCENTAGE  OF  DEATHS,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Color  and  Sex. 

Number  of  Deaths. 

Percentage. 

Total  

635,449 

100.0 

White  

520,079 

81.8 

Male  

252,742 

39.8 

Female  

267,337 

42  1 

Colored  

115,370 

18.2 

Male  

53,795 

8.5 

Female  

61,575 

9.7 

It  will  be  seen  that  a  little  more  than  four-fifths  of  the  deaths 
were  of  white  persons.  Colored  deaths  were  recorded  in  18.2%  of 
the  total  cases.  Since  only  12.5%  of  the  number  of  persons  ex- 
posed were  colored,  this  higher  representation  of  colored  persons 

11 


12 


MORTALITY   STATISTICS  OP   INSURED   WAGE  EARNERS. 


in  the  total  of  death-  indicates  the  higher  death  rate  of  that  group 
of  policyholders.  For  lx)th  white  and  colored  persons  there  were 
more  female  than  male  deaths.  This  is  accounted  for  by  the  fact 
that  there  is  a  larger  proportion  of  females  than  males  in  the  ex- 
posure. The  significance  of  these  several  relations  will  be  clearer 
when  we  proceed  to  relate  the  deaths  to  the  number  of  living,  that 
is,  when  we  compare  the  death  rates  per  1,000  persons  exposed  in 
each  cla- 

Age  Composition  of  the  Deaths. 

It  will  be  of  interest  to  inquire  also  into  the  age  composition*  of 
the  deaths  recorded  in  this  aggregate  experience  for  the  period  1911 
to  1916.  No  deaths  of  persons  under  one  year  of  age  were  in- 
cluded. Among  the  635,449  deaths  at  ages  one  year  and  over, 
58,009  or  9.1%,  were  between  the  ages  of  one  and  four  jrears. 
Slightly  more  than  one-fifth  of  the  deaths  (20.1%)  occurred  under 
the  age  of  20.  Between  the  ages  20  and  64  years,  the  main  work- 
ing period  of  life,  60.1%  of  the  deaths  occurred.  For  the  ages  65 
and  over  there  were  recorded  19.7%,  or  just  under  one-fifth  of 
the  total.  In  other  words,  there  was  approximately  the  same  pro- 
portion of  deaths  at  the  ages  65  and  over  as  at  the  group  of  ages 
under  20  years.  The  foregoing  facts  are  displayed  in  the  follow- 


ing table: 


TABLE  4. 


NUMBER  AND  PERCENTAGE  OF  DEATHS  CLASSIFIED  BY  AGE  PERIOD. 

Experience  of  Metropolitan   Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Age  Peri<xi. 

Number. 

Percentage. 

All  ages  —  one  and  over  

635,449 

100.0 

1  to  4  

58,009 

9.1 

5  to  9  

26,645 

4.2 

10  to  14  

16,606 

2.6 

15  to  19  

26,655 

4.2 

20  to  24  

35,027 

5.5 

25  to  34  

73,429 

11.6 

35  to  44  .. 

80,152 

12.6 

45  to  54  

87,734 

13.8 

55  to  64  

105,673 

16.6 

65  to  74  

97,361 

15.3 

75  and  over  .  . 

28.158 

4.4 

*  Ages  of  deceased  persons  were  classified  according  to  age  nearest  birth- 
day. The  age  period  5  to  9  years,  for  instance,  ranges  from  average  age 
4}  to  average  age  9}  years. 


MORTALITY    FROM   ALL   CAUSES. 


13 


Death  Rates  per  1,000  Persons  Exposed  for  the  Entire  Experience. 

The  635,449  deaths  reported  during  the  six  year  period  1911  to 
1916  represented  a  death  rate  of  11.81  per  1,000  exposed.  Among 
the  entire  group  of  white  persons  the  death  rate  was  11.04  per  1,000 
and  among  colored  lives,  17.22  per  1,000  exposed.  This  excess  of 
practically  one-half  in  the  colored  death  rate  will  be  treated  analyt- 
ically from  various  angles  in  the  following  text.  The  causes  of 
death  responsible  for  the  larger  part  of  this  excessive  mortality 
among  colored  persons,  with  especial  comment  upon  the  age  and 
sex  characteristics  of  the  experience,  will  also  be  duly  taken  up. 
The  following  table  gives  a  comparative  view  of  the  death  rates  per 
1,000  persons  exposed  for  each  of  the  color  and  sex  classes  of  this 
mortality  experience  for  the  entire  period  1911  to  1916 : 

TABLE  5. 

DEATHS,  AND  DEATH  RATES  PER  1,000  PERSONS  EXPOSED.    ALL  CAUSES  OF 

DEATH  COMBINED.    CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Color  and  Sex. 

Number  of  Deaths. 

Death  Rates  per  1,000 
Exposed. 

Total  

635,449 

11.81 

White  

520,079 

11.04 

Males  

252,742 

11.82 

Females  

267,337 

10.40 

Colored  

115,370 

17.22 

Males  

53,795 

17.63 

Females  

61,575 

16.89 

Considering  only  all  ages  in  this  experience  combined,  white 
females  show  the  most  favorable  mortality  record,  followed  by  white 
males  and  colored  females,  with  colored  males  exhibiting  the  highest 
death  rate  in  this  present  mortality  study  of  insured  wage  earners. 
More  detailed  comment  upon  these  differences  in  mortality  will  be 
given  in  the  following  section  on  the  age  characteristics  of  mortality 
among  insured  wage  earners. 


11 


MORTALITY    STATISTICS   OF    INSURED   WAGE   EARNERS. 


Deaths  and  death  rates  by  color,  sex  and  age  period.    All  causes  of 

death  combined. 

The  preceding  table,  giving  the  death  rates  per  1,000  persons  ex- 
posed for  each  of  the  color  and  sex  classes,  is  indeed  too  broad  in 
its  scope  to  warrant  our  drawing  any  conclusions  on  the  differences 
in  mortality  of  the  several  color  and  sex  classes.  A  conclusion  of 
this  kind  can  be  drawn  only  after  an  examination  of  the  death 
rates  for  each  of  the  color  and  sex  classes,  properly  grouped  accord- 
ing to  ages.  The  following  table  gives  the  facts  of  mortality  accord- 
ing to  age  period  in  this  experience  for  insured  wage  earners : 

TABLE  6. 
MORTALITY  FROM  ALL  CAUSES  OP  DEATH  COMBINED,  CLASSIFIED  BY  COLOR, 

SEX  AND  BY  AGE  PERIOD. 

Death  Ratea'Per  1,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored  . 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

11.81 

11.82 

10.40 

17.63 

16.89 

1  to  4  

12.86 
3.66 
2.53 
4.39 
6.43 
8.67 
12.83 
19.08 
34.56 
72.53 
135.21 

12.69 
3.64 
2.32 
3.76 
5.97 
9.24 
15.90 
23.64 
40.03 
79.68 
145.13 

11.75 
3.33 
2.16 
3.58 
5.27 
6.70 
9.23 
14.37 
28.98 
06.91 
129.16 

21.79 
5.42 
4.65 
9.32 
12.04 
14.23 
19.20 
27.64 
46.91 
84.21 
137.61 

20.77 
5.64 
5.72 
11.36 
12.57 
12.36 
16.14 
24.12 
40.17 
73.39 
135.74 

5  to  9  

10  to  14  

15  to  19  
20  to  24     

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  .  .  . 

We  shall  discuss  first  the  variation  in  the  death  rate  from  one  age 
period  to  another  for  the  total  mortality  experience.  The  age  series 
of  death  rates  shows  a  high  mortality  rate  at  the  outset,  beginning 
with  the  age  period  1  to  4  years,  followed  by  a  sharp  decline  to  a 
minimum  for  the  age  period  10  to  14  years.  In  most  mortality 
investigations,  the  minimum  death  rates  at  any  age  period  in  life 
are  usually  to  be  found  between  10  and  14  years  of  age.  There- 
after, there  occurs  a  gradually  rising  death  rate  up  to  the  highest 
age  period  in  the  series.  Not  until  we  reach  the  age  group  35 


MORTALITY    FROM   ALL    CAUSES.  15 

to  44  years  do  we  find  the  mortality  rate  approximately  as  high, 
12.83  per  1,000  persons  exposed,  as  it  was  at  the  outset  of  this 
series.  The  rate  rises  in  the  next  ten  year  divisional  period  of  life 
to  a  figure  of  19.08  per  1,000  and  in  the  succeeding  ten  year  period 
to  a  rate  of  34.56  per  1,000.  The  highest  significant  age  group  in 
this  study,  65  to  74  years,  shows  a  rate  of  72.53  per  1,000  persons 
exposed.  In  this  report  we  shall  not  place  much  emphasis  upon  our 
figures  for  the  age  group  75  years  and  over,  because  of  the  unusual 
composition  of  the  group  as  to  the  ages  of  the  persons  included  in 
it.  For  white  males  in  this  mortality  experience  we  find  the  same 
point  of  minimum  incidence  of  mortality  as  was  observed  for  the 
total  experience.  In  adult  life  however  the  rise  in  the  curve  of 
mortality  among  white  males  is  very  much  sharper  than  for  the 
total  experience.  White  females  in  this  mortality  investigation 
show  a  much  more  gradual  upward  slope  of  the  mortality  curve  in 
adult  life,  in  contrast  to  the  sharpness  of  the  upward  trend  of  mor- 
tality among  white  males  at  the  later  adult  ages.  It  should  be 
noted  that  for  colored  females  the  minimum  mortality  rate  is  found 
between  5  and  9  years  and  not  between  10  and  14  years  as  was  the 
case  for  the  other  three  main  classes  in  this  mortality  study.  We 
shall  now  consider  a  few  comparative  ratios  of  mortality  between 
the  white  and  colored  races  according  to  sex  and  between  the  two 
sexes  within  each  color  or  race  group. 

Patios  of  Mortality  of  White  and  Colored  Races  by  Age  Period, 
a.  White  Male  and  Colored  Male  Death  Rates  Compared. 

Considering  all  ages  of  the  mortality  experience  of  males,  the 
colored  show  a  mortality  rate  nearly  fifty  per  cent,  higher  than  that 
of  the  white  race.  The  ratio  of  colored  to  white  male  mortality 
varies  decidedly  with  the  several  age  periods.  In  the  ages  of  early 
adolescence,  fifteen  to  nineteen  years,  colored  male  mortality  shows 
its  greatest  ratio  of  excess  over  white  male  mortality.  The  col- 
ored male  death  rate,  at  this  age  period,  is  practically  250  per  cent, 
of  the  rate  for  white  males.  Between  five  and  twenty  years  of  age, 
for  each  five  year  period,  there  is  an  increment  of  practically  fifty 
per  cent,  in  the  excess  of  colored  male  over  white  male  mortality. 
Between  five  and  nine  years,  the  excess  of  mortality  was  prac- 
tically fifty  per  cent.,  between  ten  and  fourteen  years,  one  hundred 
per  cent.,  and  between  fifteen  and  nineteen  years,  one  hundred 


16 


MORTALITY    -T  \TISTIC8   OF   INSURED    WAGE   EARNERS. 


and  fifty  per  cent.  Beginning  with  the  age  period  twenty  to 
twenty-four  years,  there  is  a  gradual  decline  in  this  excess  of  col- 
ored male  over  white  male  mortality.  The  only  exception  is  the 
age  period  fifty-five  to  sixty-four  years,  which  shows  a  practically 
stationary  ratio  of  excess  mortality,  with  respect  to  the  preceding 
age  period  forty-five  to  fifty-four  years.  After  these  two  age 
periods,  the  rate  of  colored  male  mortality  does  not  differ  greatly 
from  that  for  white  males.  The  following  table  displays  the  ratios 
of  white  and  colored  mortality  for  males: 

TABLE  7. 
MORTALITY  FROM  ALL  CAUSES  OF  DEATH  COMBINED.    WHITE  MALES  AND 

COLORED  MALES  COMPARED. 
Death  Bates  Per  1,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

White  Males. 

Colored  Males. 

Percentage  Colored 
of  White  Rate. 

All  ages  —  one  and  over. 

11.82 

17.63 

149.2 

1  to4  

12.69 

21.79 

171.7 

5  to  9  

3.64 

5.42 

148.9 

10  to  14  

2.32 

4.65 

200.4 

15  to  19  

3.76 

932 

247.9 

20  to  24  

5.97 

1204 

201  7 

25  to  34  

924 

1423 

1540 

35  to  44  

15.90 

19.20 

120.* 

45  to  54  

23.64 

27.64 

116.9 

55  to  64  

40.03 

46.91 

117.2 

65  to  74  

79.68 

84.21 

105.7 

75  and  over  

145.13 

137.61 

94.8 

The  reduction  of  these  comparative  figures  to  graphic  form  brings 
out  a  number  of  interesting  characteristics  of  the  mortality  of  the 
two  races.  The  curve  of  the  death  rates  of  white  male  mortality, 
for  instance,  is  continuously  concave  throughout.  The  colored 
male  curve,  between  central  age  12.5  years  and  central  age  thirty 
years,  shows  a  somewhat  convex  form.  The  high  death  rate  from 
pulmonary  tuberculosis  is  the  chief  influence  at  work  to  produce 
this  significant  difference  in  the  contour  of  the  colored  mortality 
curve.  The  chief  item  of  interest  in  the  graphic  illustration  (on 
page  17)  of  these  two  curves  is  the  general  tendency  of  mortality 
among  colored  males  to  approach  mortality  among  white  males  at 
the  advanced  ages. 


MORTALITY    FROM   ALL    CAUSES. 


17 


Chart  II.— Mortality  from  All  Causes  of  Death 

Death  Rates  per  1,OOO   Persons    Exposed.      Classified    by   Age    Period*.     White 

Male*  and  Colored  Males  Compared 
Experience  of  Metropolitan  Life  Insurance  Company,  Industrial  Department,  1911  to  1916 

Death  Rate 
per  1.CCO 

JO  r— 


18 


MORTALITY   STATISTICS  OF   INSURED   WAGE  EARNERS. 


b.  White  Female  and  Colored  Female  Death  Rates  Compared. 

For  all  ages  combined,  the  mortality  among  colored  females  was 
very  nearly  two-thirds  in  excess  of  the  mortality  among  white 
females.  The  ratio  of  excess  varied  with  age  period.  The  point 
of  maximum  excess  in  colored  female  over  white  female  mortality 
occurred  in  the  age  period  fifteen  to  nineteen  years — the  period  of 
adolescence.  The  rate  for  colored  females  was  then  more  than 
three  times  as  high  as  for  white  females  (317.3%).  In  fact,  the 
tendency  of  the  colored  mortality  rate  to  diverge  from  the  white 
mortality  rate  was  more  marked  for  females  than  for  males  at  every 
age  period  of  life.  The  following  table  displays  the  figures  of 
comparative  mortality  .of  white  and  colored  females: 

TABLE  8. 

MORTALITY  PROM  ALL  CAUSES  OP  DEATH  COMBINED.    WHITE  FEMALES  AND 

COLORED  FEMALES  COMPARED. 

Death  Eates  Per  1,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

White  Females. 

Colored  Females. 

Percentage,  Colored  of 
WtUte  Rate. 

All  ages  —  one  and  over  . 

10.40 

16.89 

162.4 

1  to  4  

11.75 

20.77 

176.8 

5  to  9  

3.33 

5.64 

169.4 

10  to  14  

2.16 

5.72 

264.8 

15  to  19  

3.58 

11.36 

317.3 

20  to  24  

5.27 

12.57 

238.5 

25  to  34  

6.70 

12.36 

184.5 

35  to  44  

9.23 

16.14 

174.9 

45  to  54   

14.37 

24.12 

167.8 

55  to  64  

28.98 

40.17 

138.6 

65  to  74  

66.91 

73.39 

109.7 

75  and  over  

129.16 

135.74 

105.1 

The  contour  of  the  mortality  curve  for  colored  females  shows  de- 
cidedly more  profound  disturbance  between  central  age  12.5  year? 
and  central  age  30  years  than  did  the  curve  for  colored  males.  The 
white  female  curve  shows  a  slightly  convex  tendency  between  these 
two  central  ages.  It  will  be  recalled  that  the  white  male  curve 
was  concave  throughout.  Furthermore,  the  colored  female  curve 
is  emphatically  more  convex  between  central  ages  12.5  years  and 
30  years  than  the  colored  male  curve  between  these  limits.  It  will 


MORTALITY    FROM    ALL    CAUSES. 


19 


Chart  III.— Mortality  from  All  Causes  of  Death 

O»ith  Rates  per  1.OOO  Persona  Exposed.     Classified   by  Age   Periods.    White 

Femalea  and  Colored  Females  Compared 
Experience  of  Metropolitan  Life  Insurance  Company,  Industrial  Department,  1911  to  1918 


X        J-9    10-1*  tS-l?  20-21    2S-J4 


AGE  PERIOD 


20  MORTALITY    STATISTICS   OF    INSURED    WAGE   EARNERS. 

be  pointed  out  in  a  later  section  just  how  much  of  this  deforma- 
tion in  the  mortality  curve  for  colored  males  is  due  to  tuberculosis, 
and  for  colored  females  to  tuberculosis  and  the  diseases  and  condi- 
tions incidental  to  the  gravid  and  puerperal  states. 

The  graphic  illustration  on  page  19  gives  a  convenient  view  of  the 
course  of  white  and  colored  mortality  throughout  the  various  age 
periods  for  females. 

The  reader  will  be  inclined  to  speculate  upon  the  disproportion 
between  the  ratio  of  white  and  colored  female  mortality  and  the 
ratio  of  white  and  colored  male  mortality.  It  would  seem,  offhand, 
from  the  standpoint  of  comparative  mortality,  that  colored  females 
were  by  far  the  worse  off.  It  must  be  remembered,  however,  that 
white  male  mortality  bears  a  much  more  unfavorable  relation  to  the 
total  white  mortality  than  does  colored  male  mortality  to  the  total 
mortality  of  colored  lives.  This  situation  should  be  borne  in  mind 
in  drawing  conclusions  from  a  comparison  of  white  and  colored 
mortality  according  to  sex.  It  will  be  of  interest  and  profit,  there- 
fore, to  view  briefly  the  ratio  of  mortality  according  to  sex  within 
each  color  class. 

Ratios  of  Mortality  of  Males  and  Females  by  Age  Period. 

For  all  ages  combined,  white  male  mortality  was  about  fourteen 
per  cent,  in  excess  of  white  female  mortality.  This  ratio  was  not 
constant,  however,  for  the  several  age  periods.  Below  twenty  years 
of  age,  the  excess  of  white  male  over  white  female  mortality  was 
never  less  than  five  nor  more  than  ten  per  cent.  Beginning  with 
the  age  period  twenty  to  twenty-four  years,  with  its  central  age  at 
22.5  years,  the  excess  of  white  male  over  white  female  mortality 
began  to  assume  considerable  proportions.  In  this  age  period, 
when  white  males  begin  to  take  up  the  arduous  and  toilsome  labor 
of  the  great  mass  of  the  male  wage  earning  population,  white  male 
mortality  was  over  thirteen  per  cent,  in  excess  of  white  female  mor- 
tality. Between  twenty-five  and  thirty-four  years,  with  the  central 
age  at  thirty  years,  white  males  showed  a  mortality  rate  thirty-eight 
per  cent,  in  excess  of  the  rate  for  white  females.  Between  thirty- 
five  and  forty-four  years,  with  the  central  age  at  forty  years,  we 
find  the  maximum  point  of  excess  in  the  mortality  of  white  males 
over  that  of  white  females,  namely,  over  seventy-two  per  cent.  The 
relative  excess  of  white  male  mortality  begins  to  decline  after  that 


MORTALITY    FROM   ALL    CAUSES. 


21 


age  period,  but  thereafter  never  approaches  the  figure  for  white 
female  mortality  nearer  than  twelve  per  cent,  and  that  at  the 
highest  significant  age  period  in  this  study.  We  shall  see  later  that 
tuberculosis  and  accidents  account  for  a  very  large  part  of  this 
excess  of  white  male  over  white  female  mortality. 

As  already  suggested,  the  ratios  of  male  and  female  mortality 
among  colored  lives  present  an  emphatically  different  picture  than 
do  the  ratios  for  white  lives.  Colored  male  mortality  at  any  age 
period  is  never  in  excess  of  colored  female  mortality  by  more  than 
twenty  per  cent.  The  range  of  life  between  central  age  7.5  years 
and  central  age  22.5  years  shows  decidedly  more  favorable  mor- 
tality among  colored  males  than  among  colored  females.  Between 
ten  and  fourteen  years,  colored  male  mortality  is  nineteen  per  cent, 
more  favorable  than  colored  female  mortality.  The  particular 
causes  of  death  responsible  for  this  favorable  showing  among 
colored  males  will  be  pointed  out  in  succeeding  parts  of  this  report. 
Colored  male  mortality  is  in  excess  by  nearly  twenty  per  cent.,  the 
maximum  ratio  of  excess,  in  the  age  period  thirty-five  to  forty-four 
years.  The  following  table  gives  a  comparison  of  the  sex  ratios 
of  mortality  for  the  white  and  colored  races : 

TABLE  9. 

PERCENTAGE.  MALE  OF  FEMALE  DEATH  RATES  CLASSIFIED  BY  COLOR  AND  BY 

AGE  PERIOD. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Age  Period. 

White. 

Colored. 

All  ages  —  one  and  over  

113.7 

104.4 

1  to  4  

108.0 

104.9 

5  to  9  

109.3 

96.1 

10  to  14  

107.4 

81.3 

15  to  19  

105.0 

82.0 

20  to  24  

113.3 

95.8 

25  to  34  

137.9 

115.1 

35  to  44  

172.3 

119.0 

45  to  54  

164.5 

114.6 

55  to  64  

138.1 

116.8 

65  to  74  

119.1 

114.7 

75  and  over  

112.4 

101.4 

We  may  conclude,  then,  with  the  following  general  comment: 
among  white  persons  the  mortality  rate  of  males  is  always  in 


22  MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

excess  of  that  of  females.  This  excess  is  least  marked  below 
age  25  and  above  75,  but  not  inconsiderable  even  at  these  ages.  At 
the  point  of  greatest  difference,  namely,  at  the  age  period  35  to 
44  years,  the  male  rate  is  nearly  three-fourths  in  excess.  Among 
colored  persons,  the  picture  is  different  in  a  number  of  essential 
respects.  The  male  rate  is  lower  than  the  female  rate  under  age 
25,  with  the  single  exception  of  children  of  one  to  four  years. 
After  75  years  the  two  rates  are  much  the  same.  The  actual  death 
rate  between  25  and  75  years  is  higher  for  colored  males  than 
females,  but  the  excess  is  altogether  moderate  as  compared  with 
what  we  have  noted  among  white  lives. 

Comparison  of  Death  Rates  per  1,000  exposed.     White  Persons  in 

Insurance  Experience,  1911  to  1916,  and  General  Population 

of  Expanding  Registration  Area,  1910  to  1915. 

The  mortality  experience  of  insured  wage  earners,  1911  to  1916, 
may  now  be  compared  profitably  with  that  for  the  general  popula- 
tion of  the  expanding  Registration  Area  of  the  United  States,  1910 
to  1915.  A  number  of  limitations  to  the  completeness  of  this  com- 
parison must  first  be  pointed  out.  We  must  make  the  comparison 
in  the  first  place  between  the  experience  of  white  insured  lives  on 
the  one  hand  and  the  total  population,  white  and  colored,  of  the 
expanding  Registration  Area,  on  the  other.  This  is  because  the 
white  insurance  experience  is  most  like  that  of  the  Registration 
Area  from  which  the  small  proportion  of  colored  cannot  accurately 
be  eliminated.  The  proportion  of  colored  persons  in  the  insurance 
experience  for  1911  to  1916  (12.5%)  is  large  and  affects  the  total 
Metropolitan  death  rate  too  much  to  permit  a  comparison  with  the 
rate  of  the  total  Registration  Area,  with  its  very  much  smaller  pro- 
portion of  colored  lives.  It  must  be  remembered  also  that  at  the 
time  this  comparison  is  being  made  there  are  available  for  the  Reg- 
istration Area  only  the  data  for  the  years  1910  to  1915  according 
to  sex  and  age  period.  This  constitutes  a  six-year  period  not  very 
different  from  the  period  1911  to  1916  for  which  the  insurance  data 
are  at  hand.  There  are  other  differences-  of  area,  occupational  com- 
position, etc.,  to  which,  reference  has  already  been  made.  But  all 
considered,  the  differences  in  the  figures  which  we  shall  point  out 
fairly  represent  a  true  difference  in  the  vitality  of  the  two  groups. 

The  annual  reports  of  the  United  States  Bureau  of  the  Census  on 


MORTALITY    FROM   ALL   CAUSES. 


23 


mortality  statistics  for  the  years  1910  to  1915  give  tables  showing 
the  number  of  deaths  classified  by  sex  and  age  period  and  for  each 
of  the  diseases  or  causes  of  death  in  the  International  List.  There 
is,  however,  no  corresponding  record  giving  an  official  estimate  of 
the  populations  exposed  to  risk  in  the  Registration  Area  at  the  sev- 
eral age  periods  and  by  sex.  In  order  to  compute  death  rates  it 
is  necessary  first,  to  estimate  such  population  exposure.  This  was 
obtained  by  combining  the  estimated  populations  for  each  sex  and 
age  class  in  the  expanding  Registration  Area  for  each  year  from 
1910  to  1915  inclusive.  Our  thanks  are  due  to  Dr.  F.  L.  Hoffman, 
Third  Vice-President  and  Statistician  of  the  Prudential  Insurance 
Company  of  America,  who  placed  at  our  disposal  these  estimates  of 
population. 

The  following  tables  show  the  death  rates  per  1,000  living,  for 
each  of  the  sexes,  in  the  Registration  Area,  1910  to  1915,  and  a 
comparison  with  similar  data  for  insured  white  males  and  females : 

TABLE  10. 

MORTALITY  FROM  ALL  CAUSES  OF  DEATH. 

Death  Sates  Per  1,000  Persons  Exposed.    Classified  by  Sex  and  by  Age 
Period.     White  Lives  in  Experience  of  Metropolitan  Life  Insurance 
Company,  Industrial  Dept.,  1911  to  1916,  and  Estimated  Gen- 
eral Population  of  Expanding  Eegistration  Area, 
United  States,  1910  to  1915. 


Males. 

Females. 

Age  Period. 

M.  L.  I.  CO. 
(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

All  ages  —  one 
and  over  

11.82 

12.41 

95.2 

10.40 

11.08 

93.9 

1  to  4  

12.69 

12.28 

103.3 

11.75 

11.28 

104.2 

5  to  9  

3.64 

3.32 

109.6 

3.33 

3.03 

109.9 

10  to.  14  

2.32 

2.29 

101.3 

2.16 

2.12 

101.9 

15  to  19  

3.76 

3.72 

101.1 

3.58 

3.45 

103.8 

20  to  24  

5.97 

5.42 

110.1 

5.27 

4.96 

106.3 

25  to  34  

9.24 

6.81 

135.7 

6.70 

6.10 

109.8 

35  to  44  

15.90 

10.05 

158.2 

9.23 

8.03 

114.9 

45  to  54  

23.64 

16.03 

147.5 

14.37 

12.58 

114.2 

55  to  64  

40.03 

29.88 

134.0 

28.98 

24.48 

118.4 

65  to  74  

79.68 

59.13 

134.8 

66.91 

51.72 

129.4 

75  and  over.  . 

145.13 

138.72 

104.6 

129.16 

132.99 

97.1 

The  facts  for  all  ages  combined  in  the  two  mortality  experiences, 
on  their  face,  indicate  a  more  favorable  mortality  among  insured 


24  MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 

white  persons  than  among  the  general  population.  These  figures 
are  of  significance,  however,  only  with  respect  to  the  specific  sex 
and  age  classes  of  the  data.  We  shall  see  below  that  this  favorable 
condition  for  all  ages  results  from  the  peculiar  age  distribution  of 
the  group  of  policyholders.  A  larger  proportion  of  policyholders 
appears  at  the  ages  of  low  mortality  and  a  smaller  proportion  at  the 
ages  of  high  death  rates  than  occurs  in  the  general  population. 
Let  us  make  a  comparison  first  of  the  figures  for  males,  remember- 
ing throughout  this  discussion  that  the  data  for  the  insured  group 
relate  entirely  to  white  lives. 

The  first  fact  of  importance  in  this  comparative  view  of  the  mor- 
tality of  wage  earners  and  of  the  general  population  is  that  for  all 
ages  under  25  years  there  is  no  marked  divergence  between  the  rates 
for  the  two  groups  under  review.  There  are  differences,  of  course, 
but  these  are  not  great.  Beginning  with  the  age  group  25  to  34  years 
and  thereafter  there  is,  however,  a  marked  excess  in  the  rate  of  mor- 
tality among  insured  male  wage  earners  over  that  among  males  in 
the  general  population.  At  these  age  periods,  the  special  stresses 
of  adult  life  and  of  employment  in  arduous  labor  make  themselves 
felt  in  the  mortality  experience  of  males  in  an  industrial  life  in- 
surance company.  Male  insured  wage  earners  in  the  age  period  25 
to  34  years,  show  a  mortality  rate  nearly  36%  in  excess  of  the  rates 
prevailing  among  males  in  the  general  population.  The  divergence 
between  the  two  series  of  mortality  figures  increases  somewhat  in 
the  next  age  period,  35  to  44  years,  to  58%,  and  then  declines  to  48% 
between  45  and  54  years.  Thereafter  the  excess  of  mortality  among 
male  insured  wage  earners  is  practically  stationary  at  about  35%. 
After  age  75,  the  figures  are  of  no  great  value.  It  will  be  the 
function  of  the  succeeding  sections  of  this  report  on  the  several 
causes  of  death  to  point  out  in  greater  detail  the  reasons  for  this 
percentage  of  excess  mortality  among  insured  male  wage  earners. 

The  comparative  table  for  the  death  rate  of  insured  females  in 
the  families  of  wage  earners  and  of  females  in  the  general  popula- 
tion shows  no  such  striking  excesses  of  mortality  as  were  observed 
in  the  table  for  males.  Under  the  age  of  35  years  there  are  no 
marked  divergences  of  the  mortality  curve.  After  35  years  the  ex- 
cess of  the  mortality  rate  among  insured  females  becomes  significant. 
For  the  age  group  35  to  44  years  we  observed  an  excess  of  15%, 
which  ratio  is  about  the  same  as  that  for  the  succeeding  age 
group,  45  to  54  years.  For  the  divisional  period  55  to  64  years 


MORTALITY    FROM    ALL   CAUSES.  25 

•we  notice  an  excess  of  18%  and  for  the  age  group  65  to  74  years 
an  excess  of  29%  in  the  mortality  rates  of  insured  females.  The 
reader  will  observe  a  marked  peculiarity  in  the  course  of  the  ratio 
of  excess  mortality  of  insured  females  as  compared  with  that  re- 
corded for  insured  males.  In  the  latter  group  there  was  a  sharp 
rise  in  the  ratio  of  excess  mortality  from  age  20  up  to  and  includ- 
ing the  age  period  35  to  44  years  and  a  decline  for  the  age  groups 
thereafter.  Among  insured  females,  however,  there  was  no  im- 
portant excess  in  the  mortality  rates  under  35  years  of  age  over 
the  rates  for  females  in  the  general  population,  but  a  gradually  ris- 
ing rate  for  each  age  period  thereafter  up  to  and  including  the  last 
significant  divisional  group,  65  to  74  years.  The  explanation  for 
the  difference  between  one  series  of  ratios  and  the  other  will  be 
found  only  upon  careful  analysis  of  the  facts  for  the  particular 
causes  of  death  in  the  mortality  experience. 

Factors  Influencing  Industrial  Insurance  Mortality, 

Before  proceeding  with  any  further  comparison  between  the  mor- 
tality experience  of  this  group  of  insured  wage  earners  and  the 
mortality  experience  of  the  general  population,  it  will  be  instructive 
to  outline  briefly  some  of  the  important  factors  which  condition 
the  mortality  experience  of  an  industrial  life  insurance  company, 
and  which  are  not  prevalent  in  the  general  population. 

The  first  important  source  of  difference  is  that  these  data 
relate  entirely  to  a  group  of  wage  earners  and  their  families — 
independent,  self-reliant  wage  earners,  to  be  sure,  who  have  endeav- 
ored to  protect  themselves  as  much  as  possible  from  the  losses  inci- 
dent to  the  last  illness  and  the  cost  of  burial.  The  great  mass  of 
the  wage  earning  population  in  America,  however,  are  not  in  ordi- 
nary times  as  well  situated  to  safeguard  themselves  against  the 
effects  of  accident  and  disease  as  are  the  better  situated  strata  of 
the  population.  The  occupations  they  engage  in  are  more  hazard- 
ous, their  families  are  larger  and  their  incomes  smaller  than  those 
of  the  general  average  of  the  population.  These  factors  determine 
such  important  health  situations  as  the  adequacy  of  diet,  housing, 
clothing,  and  equally,  the  standards  of  medical  service  at  their  dis- 
posal. These  policyholders,  too,  live  in  the  larger  cities  and  towns, 
and  are  subjected  to  the  unfavorable  influences  of  city  life.  It 
may  be  expected,  therefore,  that  the  mortality  experience  of  this 


26  MORTALITY    STATISTICS  OF   INSURED  WAGE  EARNERS. 

large  group  of  insured  wage  earners  will  show  characteristics  quite 
different  from  those  of  the  general  population  or  of  special  groups 
in  the  general  population  which  have  distinctly  better  living  and 
working  conditions.  It  is  perhaps  one  of  the  chief  functions  of 
this  report  to  point  out  definite  lines  of  further  inquiry  into  the 
general  welfare  of  the  wage  earning  group  of  the  population.  The 
more  detailed  and  specialized  questions  as  to  the  adequacy  of  wages, 
the  level  of  the  standard  of  living  of  American  workingmen's  fami- 
lies, of  housing  conditions,  of  hours  of  labor,  of  the  intensity  of 
labor,  and  of  hygienic  conditions  in  workshops  and  factories  should 
be  submitted  to  careful  and  conclusive  inquiry.  The  supply  of 
data  on  these  important  vital  facts  is  at  present  severely  limited. 
These  mortality  statistics  provide,  we  believe,  a  sound  point  of 
departure  for  such  qualified  inquiry  into  the  facts  of  the  life  and 
work  of  the  American  wage  earner. 

Downward  Trend  of  Mortality  of  Insured  Wage  Earners  from  1911 

to  1916. 

The  important  feature  of  this  mortality  experience  is  the  capac- 
ity for  decrease  shown  by  the  death  rate  in  the  brief  period  covered  by 
this  study.  In  the  six  years  1911  to  1916  inclusive,  the  death  rate 
fell  from  12.53  to  11.68  per  1,000  exposed,  or  a  decline  of  6.8%. 
Between  the  five  years  1911  to  1915  the  tendency  was  steadily  down- 
ward year  after  year.  It  was  only  in  1916  that  this  tendency  was 
checked,  apparently  as  the  result  of  a  widespread  prevalence  of 
acute  respiratory  diseases,  chiefly  of  the  influenzal  type.  But  even 
this  serious  condition  had  only  a  minor  effect,  raising  the  death 
rate  by  .4  per  1,000  persons  exposed  over  the  figure  for  1915. 

The  amount  of  decline  is  much  more  marked  if  we  consider 
white  lives  only.  Between  1911  and  1916,  the  per  cent,  decline 
among  white  lives  was  7.2.  There  is  also  a  slight  difference  in 
the  amount  of  improvement  in  the  two  sexes,  the  per  cents,  of 
decline  among  white  males  and  white  females  being  6.0  and  8.2  re- 
spectively. For  colored  persons,  the  decrease  was  only  1.4%. 
There  were  fluctuations  in  the  colored  rates  in  an  upward  and  down- 
ward direction  during  the  several  years.  The  colored  males  show 
an  actual  increase  of  1.4%  in  mortality  while  the  colored  females 
show  an  improvement  of  3.7%.  The  following  table  gives  the 
death  rates  for  the  several  groups  of  insured  wage  earners  for  each 
of  the  years  1911  to  1916  and  for  the  entire  six-year  period: 


MORTALITY    FROM   ALL    CAUSES. 


27 


TABLE  11. 

MORTALITY  FROM  ALL  CAUSES  OP  DEATH  COMBINED. 

AND  BY  SEX. 


CLASSIFIED  BY  COLOR 


Death  Bates  Per  1,000  Persons  Exposed.    Single  Years  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

11.81 

11.82 

10.40 

17.63 

16.89 

1916  

11.68 
11.31 
11.53 
11.99 
12.01 
12.53 

11.83 
11.05 
11.48 
12.20 
11.97 
12.58 

10.21 
10.04 

10.18 
10.49 
10.55 
11.11 

17.68 
17.42 
17.38 
17.90 
17.98 
17.42 

16.85 
17.12 
16.51 
16.29 
17.12 
17.50 

1915  

1914  

1913  

1912  

1911  

Reduction  of  Mortality  in  the  General  Population  of  the  Expanding 
Registration  Area  and  among  Insured  Wage  Earners  Compared. 

For  purposes  of  comparison,  we  must  again  turn  to  the  facts  for 
the  general  population  as  reflected  in  the  figures  of  the  expanding 
Registration  Area.  These  figures  will  indicate  whether  the  marked 
improvement  which  we  have  observed  among  insured  lives  is  par- 
alleled by  the  conditions  in  the  general  population  or  whether  the 
insured  have  enjoyed  conditions  which  were  especially  favorable  to 
them.  In  view  of  the  fact  that  the  detailed  figures  for  1916  for  the 
Registration  Area  are  not  as  yet  available  and  also  because  the  in- 
surance experience  begins  with  1911,  we  shall  limit  our  comparison 
of  the  two  experiences  to  the  five-year  period  1911  to  1915 
inclusive. 

For  the  total  Registration  Area  of  the  United  States  there  was 
observed  between  1911  and  1915  a  decline  of  only  4.7  per  cent. 
This  compares  with  a  9.7  per  cent,  decline  among  the  white  in- 
sured group  in  the  same  five  year  period.  It  must  be  remembered 
also  that  the  insurance  figures  do  not  include  facts  for  infants  under 
one  year  of  age  as  do  the  foregoing  data  for  the  Registration  Area 
of  the  "United  States.  The  improvement  in  infant  mortality  dur- 
ing the  period  under  examination  has  been  very  marked  and  this 
undoubtedly  has  had  a  very  favorable  influence  on  the  total  death 
rate  of  the  Registration  Area.  If  the  expanding  Registration 


28  MORTALITY    STATISTICS   OF    INSURED    WAGE   EARNERS. 

Area  data  at  all  ages  were  to  be  arranged  for  only  those  lives  abore 
one  year  of  age,  as  is  the  case  for  the  Metropolitan  experience,  a 
less  favorable  reduction  than  4.7%  would  undoubtedly  be  found 
and  the  advantage  in  favor  of  the  insured  would  be  even  more 
striking. 

In  order  to  compare  the  facts  for  each  of  the  two  sexes,  we  may 
safely  use  the  figures  for  all  males  in  the  Registration  Area  and 
contrast  them  with  those  for  white  males  in  the  insurance  expe- 
rience, because  the  composition  of  the  Registration  Area  is  sub- 
stantially white.  Between  1911  and  1915,  males  in  the  Registra- 
tion Area  showed  a  reduction  of  exactly  5%  in  mortality  as  com- 
pared with  a  percentage  reduction  of  12.2  among  the  insured 
white  males.  Females  in  the  general  population  at  all  ages  show 
a  decline  of  only  4.3%,  as  compared  with  a  decline  of  9.6%  among 
insured  white  females  at  ages  one  and  over.  Taking  all  white  lives 
together,  the  insured  group  showed  a  decline  in  mortality  of  eleven 
per  cent,  and  all  the  white  lives  in  the  Registration  Area  a  decline 
of  only  5.4%. 

The  percentage  of  decline  of  mortality  among  colored  lives  was 
more  pronounced  for  the  general  population  than  for  insured  col- 
ored wage  earners,  but  was  small  in  each  instance.  The  group  of 
colored  persons  in  the  population  of  the  Registration  Area  showed 
a  reduction  of  2.7  per  cent.,  whereas,  the  entire  group  of  colored 
lives  in  the  insurance  experience  showed  a  reduction  of  only  1.2% 
between  1911  and  1915.  This  improvement  was  entirely  confined 
to  the  colored  females.  The  percentage  of  decline  of  colored  mor- 
tality in  the  general  population  and  among  insured  wage  earners 
does  not  affect  a  very  large  number  of  lives  exposed  in  either  experi- 
ence and  may  be  disregarded  for  comparative  purposes  in  the 
present  discussion.  This  can  readily  be  done  in  view  of  the  fact 
that  insured  colored  persons  are  located  almost  entirely  in  urban 
areas,  whereas  a  fair  proportion  of  the  negroes  in  the  Registration 
Area  are  rural  dwellers.  It  will  be  seen,  therefore,  that  the  mor- 
tality experience  of  insured  white  wage  earners  shows  by  far  the 
more  favorable  general  tendency  when  compared  with  the  mortality 
experience  of  the  general  population. 

The  following  table  presents  a  comparison  of  the  death  rates  of 
the  aggregate  white  and  colored  groups  among  the  insured  and  the 
general  population  for  the  period  1911  to  1915  as  well  as  the  per 
cent,  reduction  between  the  two  periods. 


MORTALITY    FROM    ALL    CAUSES. 


29 


TABLE  12. 

MORTALITY  FEOM  ALL  CAUSES  OF  DEATH  COMBINED. 

Death  Bates  Per  1,000  Persons  Exposed,   1911   to  1915. 

White  and  Colored  Lives,  Males  and  Females,  of  Expanding  Kegistration 

Area  of  the  United  States  and  in  Experience  of  Metropolitan  Life 

Insurance  Company,  Industrial  Department,  Compared.* 


Year. 

White  IJves. 

Colored  Lives. 

Males. 

Females. 

Reg. 

Area. 

M.  L.I. 
Co. 

Reg. 

Area. 

M.  L.I. 
Co. 

Reg. 
Area. 

M.  L.  I. 
Co.  Wh. 
Males. 

Reg. 

Area. 

M.  L.  I. 

Co.  Wb. 
Females. 

1915  

13.00 
13.16 
13.65 
13.47 
13.74 

10.49 
10.77 
11.26 
11.20 
11.79 

23.04 
21.96 
21.92 
22.92 
23.69 

17.26 
16.90 
17.02 
17.51 
17.46 

14.26 
14.46 
15.00 
14.75 
15.01 

11.05 
11.48 
12.20 
11.97 
12.58 

12.69 
12.71 
13.09 
12.94 
13.26 

10.04 
10.18 
10.49 
10.55 
11.11 

1914  

1913  

1912  

1911  

Per  cent  de- 
cline  1911 
to  1915..  . 

[5.39 

11.03 

2.74 

1.15 

5.00 

12.16 

4.30 

9.63 

*  Kegistration  Area  rates  are  for  all  ages ;  insurance  experience  applies 
only  to  ages  one  and  over. 

A  more  intimate  view  of  these  two  experiences  will  be  afforded 
when  the  data  for  each  of  the  important  diseases  and  conditions  are 
taken  up.  In  these  later  sections  we  shall  direct  attention  to  the 
conditions  which  are  largely  responsible  for  the  progressively  favor- 
able mortality  of  white  insured  lives  as  compared  with  the  general 
population  of  the  expanding  Registration  Area  of  the  United  States. 


CHAPTER  III. 
MORTALITY  FBOM  PRINCIPAL  CAUSES  OF  DEATH. 

The  main  outlines  of  the  mortality  experience  of  insured  wage 
earners  for  all  causes  of  death  combined  appear  in  the  foregoing 
text.  Data  of  this  type,  however  valuable,  are  rather  bare  in  their 
public  health  value  unless  supplemented  by  further  analysis  accord- 
ing to  the  principal  diseases  and  conditions  responsible  for  the  mor- 
tality. It  is  one  of  the  favorable  features  of  this  report  that  we 
were  able  to  secure  exceptionally  complete  statistics  of  the  causes 
of  death  in  the  course  of  our  tabulations.  The  documents  avail- 
able for  our  study,  namely,  the  so-called  "claim  papers"  contain, 
usually,  a  number  of  statements  of  the  disease  or  condition  causing 
death.  The  most  important  of  these  is,  of  course,  the  certificate  as 
submitted  by  the  attending  physician,  who,  in  the  great  majority  of 
the  cases,  also  completes  the  official  death  certificate  for  the  use  of 
the  general  registration  service  of  the  community  in  which  the  in- 
sured person  dies.  There  are  also  at  hand  the  statements  of  the 
cause  of  death  as  made  by  the  beneficiary,  who  represents  the  fam- 
ily of  the  deceased,  as  well  as  that  completed  by  the  local  represen- 
tatives of  the  company.  Often  newspaper  clippings  and  other  il- 
luminating additions  are  attached  to  the  papers,  and  especially  in 
cases  of  accidental  death  or  where  a  coroner's  inquest  is  called  for. 

Effort  to  Improve  Accuracy  of  Certified  Causes  of  Death. 

Every  effort  has  been  made  in  the  conduct  of  this  mortality  study 
to  secure  from  certifying  physicians  as  complete  and  accurate  state- 
ments of  the  diseases  or  conditions  causing  death  as  practicable. 
This  end  was  achieved  by  means  of  an  extensive  system  of  corre- 
spondence with  the  certifying  physicians,  pointing  out  where  cer- 
tain forms  of  statements  of  diseases  causing  death  were  unsatis- 
factory for  statistical  use,  and  what  manner  of  additional  clarify- 
ing information  we  desired  to  have.  A  few  examples  may  be  cited 
to  illustrate  the  procedure. 

1.  The  physician  reports  on  the  death  certificate  that  a  child  has  died 
from  ' '  bronchopneumonia. "  In  view  of  the  fact  that  this  disease  or  condi- 

30 


MORTALITY    FROM   PRINCIPAL    CAUSES   OF   DEATH.  31 

tion  is  so  often  a  terminal  state  of  infectious  disease,  our  letter  asked  the 
physician  to  say  whether  any  infection,  such  as  measles  or  whooping  cough, 
or  whether  trauma  was  the  primary  causative  condition.  In  numerous  in- 
stances, physicians  replied  to  our  inquiries  and  said  that  they  had  omitted 
to  certify  to  the  primary  infection  or  condition,  i.  e.,  measles,  whooping 
cough,  scarlet  fever,  etc. 

2.  "Peritonitis"  is  also  a  statement  of  cause  of  death  which  does  not 
convey  to  the  compiling  statistician  the  information  he  must  have  in  order 
to  report  upon  the  prevalence  of  the  socially  important  primary  diseases  and 
conditions  which  result  in  fatal  "peritonitis."     In  this  instance,  the  letter 
of  inquiry  asks  the  physician  whether  the  "peritonitis"  followed  a  surgical 
operation  for  any  one  of  many  conditions  such  as  appendicitis,  ulcer  of  the 
stomach,  cancer  of  the  stomach  or  of  the  intestines,  etc.,  or  whether,  in  the 
case  of  a  woman  of  child-bearing  age,  the  "peritonitis"  was  the  sequel  of 
any  condition  associated  with  the  maternal  state.     The  facts  of  mode  and 
nature  of  accidental,  homicidal  or  suicidal  injury,  were  also  inquired  for. 

3.  "Injury"  is  a  report  which  may  be  properly  chargeable  to  either 
of   the   primary    subdivisions   of   violence:    suicide,   homicide   or   accident. 
These,  in  turn,  are  classified  accurately  only  if  the  means  of  "injury"  is 
given.     A  death  reported  in  this  way,  if  it  was  suicidal,  may  have  been 
primarily  due  to  suicide  by  gunshot  wound,  or  by  a  cutting  instrument,  or 
by  jumping  from  a  high  place;  if  accidental,  the  means  of  "injury"  may 
have  been  a  firearm,  a  cutting  instrument,  an  accidental  fall,  a  fall  or  an 
explosion  in  a  mine  or  quarry — death  may  have  been   due,  indeed,  to  a 
machinery  accident,  a  railroad  accident,  a  street-car  accident,  or  to  any  one 
of  many  accidental  causes.     Inasmuch  as  the  International  List  of  Causes 
of   Death   provides  for  the  separate   grouping  of   each   of   the   means   of 
"injury"  cited  above,  we  can  not  classify  a  report  like  "injury,"  "frac- 
ture," "wound,"  " traumatism, "   or  any  of  many   similar  reports  with 
accuracy  unless  information  is  provided  as  to  the  means  or  manner  in  which 
the  "injury,"  etc.,  occurred.     The  letter  of  inquiry  sent  to  the  certifying 
physician  in  such  cases  usually  results  in  the  receipt  of  data  covering  th» 
additional  circumstances  that  are  required  for  the  final  assignment  of  the 
cause  of  death. 

These  three  examples,  of  many,  indicate  in  general  the  principle 
underlying  this  method  of  clearing  up  indefinite  and  otherwise  un- 
satisfactory reports  of  diseases  or  conditions  causing  death.*  In 
another  publication,!  there  will  be  found  a  rather  complete  discus- 
sion of  the  methods  and  results  of  this  inquiry  system  and  the  prob- 

*  Other  indefinite  terms  subject  to  inquiry  are:  "Accident,"  "operation," 
"acute  nephritis,"  "meningitis,"  "tumor,"  " septieemia, "  and  many 
others. 

t ' '  Improvement  of  Statistics  of  Cause  of  Death  through  Supplementary 
Inquiries  to  Physicians."  Quarterly  Publications  of  the  American  Statis- 
tical Association,  June,  1916. 


32  MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

able  effect  of  the  method  in  improving  the  precision  of  the  state- 
ment of  the  various  primary  causative  factors  in  mortality.  There 
were  received  from  certifying  physicians  in  connection  with  the 
deaths  reported  in  this  six  year  mortality  investigation  about  25,000 
letters.  In  the  great  majority  of  cases,  the  information  conveyed 
by  these  letters  made  it  possible  for  us  to  reach  a  much  closer  ap- 
proximation to  the  real  facts  respecting  the  several  important  dis- 
eases and  conditions  among  insured  wage  earners.  An  analysis  of 
the  returns  from  the  inquiry  procedure  shows  that  in  a  period  of 
six  years  the  death  rate  for  such  an  undesirable  title  as  "frac- 
tures" was  reduced  65%,  for  "simple  peritonitis"  the  reduction 
was  41%  and  for  "  acute  nephritis  "21%.  The  registration  of  cer- 
tain more  definite  causes  of  death  was  improved;  for  example, 
measles  and  scarlet  fever  showed  an  increase  of  3%  each,  cancer 
of  the  breast  5%,  tuberculous  meningitis  nearly  13%,  syphilis 
97%,  and  gonococcus  infection  138%, — all  through  the  direct  in- 
fluence of  this  inquiry  method.  Appendix  C  shows  the  number 
of  deaths  charged  to  certain  causes  before  and  after  inquiry,  and 
the  percentage  of  changes  in  classification. 

Nomenclature  and  Classification  of  Diseases. 

If  no  pains  were  spared  to  secure  complete  original  data  on  the 
diseases  and  conditions  responsible  for  mortality  among  insured 
wage  earners,  every  effort  was  also  made  to  handle  the  material 
received  by  the  Statistical  Bureau  in  a  manner  so  approved  that 
the  tabulations  would  be  comparable  with  those  of  the  best  statis- 
tical offices  of  the  country  and  especially  the  Federal  Bureau  of 
the  Census.  The  diseases  and  conditions  causing  death  reported 
upon  the  certificates  were  compiled  according  to  the  "Interna- 
national  List  of  Causes  of  Death."  The  great  variety  of  terms 
used  by  physicians  in  various  parts  of  the  country  were  thus 
brought  together  and  made  to  agree  with  the  standard  nomenclature 
as  followed  by  the  Census  Bureau.  In  addition,  the  rules  and  regu- 
lations of  the  "Manual  of  the  International  List  of  Causes  of 
Death"  were  followed  in  handling  "jointly  reported  causes  of 
death."  While  published  statistics  of  causes  of  death  are  neces- 
sarily stated  in  terms  of  single  diseases  or  conditions,  physicians 
on  their  certificates  often  give  a  number  of  such  causes.  The  rules 
of  the  Manual  indicate  clearly  the  procedure  to  follow  in  such 


MORTALITY    FKOM    PRINCIPAL    CAUSES   OF   DEATH.  33 

cases  and  these  were  strictly  adhered  to.  The  list  of  precedents  of 
the  Bureau  of  the  Census  as  published  in  the  "Index  of  Joint 
Causes — 1914  "  served  also  as  our  guide  in  the  treatment  of  "  jointly 
reported  causes  of  death."  The  results  of  this  mortality  experience 
for  insured  wage  earners  are,  therefore,  substantially  comparable 
with  the  facts  published  for  the  Eegistration  Area. 

To  carry  on  this  work,  as  well  as  to  tabulate  the  various  non-med- 
ical items  of  our  study,  it  was  necessary  to  organize  a  specially 
selected  and  trained  staff.  Virtually  every  item  appearing  in  this 
volume  was  codified  by  one  clerk  and  checked  by  another.  The 
sorting  and  tabulation  processes  were  in  like  manner  always  certi- 
fied as  to  their  accuracy.  The  watchword  throughout  the  whole 
study  conducted  over  a  period  of  six  years  has  been  "  care."  These 
precautions  have  been  taken  because  it  was  felt  from  the  very  be- 
ginning that  we  should  do  all  in  our  power  to  offset  the  inherent 
deficiencies  in  the  material  as  returned  by  physicians;  for,  even  in 
large  cities,  where  the  best  conditions  of  medical  practice  prevail, 
there  is  a  certain  irreducible  amount  of  uncertainty  and  inaccuracy 
in  statements  of  cause  of  death.  We  have  felt  that  these  should 
not  be  augmented  through  any  element  of  indifference  or  careless- 
ness in  the  statistical  procedure  followed.  It  is  our  firm  belief  that 
we  have  in  this  mortality  investigation  of  insured  wage  earners  as 
accurate  and  authentic  a  record  of  the  principal  diseases  and  condi- 
tions causing  death  as  it  has  ever  been  possible  to  obtain  in  any 
similar  enterprise  anywhere. 

The  following  table  presents  a  list  of  the  number  of  deaths  and 
of  the  death  rates  per  one  hundred  thousand  persons  exposed  for 
each  of  the  titles  in  the  detailed  International  List  of  Causes  of 
Death. 


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DISEASES  or  TRB  NBR 

SYSTEM  AND  Or  THB  OR 
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<«        o;    M    o    QW 

00 

42  MORTALITY    STATISTICS  OF  INSURED  WAGE   EARNERS. 

The  remainder  of  this  report  will  be  concerned  with  a  detailed 
consideration  of  the  more  important  diseases  and  conditions  which 
appear  in  this  experience.  These  will  be  taken  up  in  the  order  of 
their  numerical  importance.  At  this  point  we  need  point  out  only 
that,  as  in  most  other  experiences,  a  few  conditions  account  for  the 
larger  part  of  the  mortality.  Tuberculosis  (all  forms),  for  ex- 
ample was  responsible  for  17.4%  of  all  the  deaths.  This  title  was 
followed  by  "organic  diseases  of  the  heart"  with  11.9% ;  by  pneu- 
monia (all  forms),  with  9.1% ;  and  by  Bright's  disease  with  8.2% 
of  all  the  deaths.  The  entire  group  of  "  external  causes,"  of  which 
accidents  form  the  largest  part,  was  responsible  for  8.0%.  To- 
gether these  five  principal  disease  groups  accounted  for  54.6%  of 
the  total  mortality.  In  addition,  we  may  mention  cancer  (all 
forms)  with  5.9%  of  the  deaths,  cerebral  hemorrhage  and  apoplexy 
with  5.8%  and  the  four  communicable  diseases  of  childhood, 
namely,  measles,  scarlet  fever,  whooping  cough  and  diphtheria, 
which,  together,  accounted  for  4.0%.  These,  added  to  the  figure 
already  noted,  bring  the  total  up  to  70.3%  of  all  the  deaths.  We 
shall  now  consider  each  of  the  conditions  in  the  order  named,  and 
shall  add  a  number  of  others  which  seem  to  be  of  sufficient  value 
to  merit  discussion  because  of  their  great  interest  to  medical  science 
or  because  they  throw  light  on  the  vital  phenomena  of  wage  earners 
and  their  families. 


CHAPTEE  IV. 

TUBERCULOSIS. 

Notwithstanding  the  great  development  in  America  of  the  cam- 
paign against  tuberculosis,  detailed  statistics  of  mortality  from 
this  condition  are  not  as  yet  available  for  the  general  population 
in  a  manner  suitable  for  the  purposes  either  of  intensive  study  or 
of  practical  health  work.  The  present  collection  of  data  of  mor- 
tality from  tuberculosis  among  wage  earners  presenting  the  facts 
in  full  for  color,  sex  and  age,  constitutes  therefore  an  important 
contribution  to  the  literature  on  the  subject.  The  value  of  these 
figures  is  commensurate  with  the  gravity  of  the  condition.  For 
not  only  is  tuberculosis  the  first  cause  of  death  as  to  incidence 
among  wage  earners  and  their  families,  but  mortality  from  this 
cause  is  most  pronounced  at  a  time  in  life  when  there  is  still  con- 
siderable expectation  remaining  to  each  individual  and  when  death 
seriously  disrupts  family  life.  The  economic  losses  thus  entailed 
are  still  further  augmented  by  the  long  periods  of  physical  disabil- 
ity which  usually  precede  the  fatal  termination.  Tuberculous  dis- 
ease is  clearly  the  chief  burden  upon  the  vital  resources  of  wage 
earners  and  their  families.  The  figures  we  present,  it  is  hoped, 
will  become  a  point  of  departure  for  further  inquiry  into  the  pos- 
sible effect  of  environmental  and  other  factors  which  condition  the 
physical  welfare  of  the  great  mass  of  the  wage  earning  population. 

Tuberculosis  in  all  its  forms  accounted  for  110,363  deaths  or 
17.4%  of  the  635,449  deaths  in  the  entire  Industrial  mortality  ex- 
perience for  the  six  year  period,  1911  to  1916.  The  deaths  cover 
a  number  of  conditions  which  are  clearly  distinguishable  according 
to  the  main  organs  or  parts  of  the  body  affected  by  the  tuberculous 
infection.  The  following  table  shows  the  number  of  deaths  re- 
sulting from  each  of  the  several  forms  of  tuberculosis  as  distin- 
guished in  the  nomenclature  of  the  International  List : 


43 


44 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


TABLE  14. 

MORTALITY  FROM  TUBERCULOSIS,  SPECIFIED  ACCORDING  TO  ORGANS  OR  PARTS 
AFFECTED.    DEATHS,  AND  DEATH  RATES  PER  100,000  PERSONS  EXPOSED. 

All  Color  and  Sex  Groups  Combined. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Organ  or  Part  Affected. 

All  Color  and  Sex  Croupe  In  Mortality  Experience. 

No.  of 
Deaths. 

Percentage 
of  Total, 
All  Causes. 

Percentage 
of  Total 
Tubercu- 
loals. 

Rat*  per 
100.000 
Exposed. 

Tuberculosis  —  all  forms  

110,363 

17.4 

100.0 

205.1 

Tuberculosis  of  the  lungs  .  .  . 
Acute  miliary  tuberculosis  .  . 
Tuberculous  meningitis  

93,526 
6,380 
4,647 
3,155 
866 
573 
959 
257 

14.7 
1.0 
.7 
.5 
.1 
.1 
.2 
t 

84.7 
5.8 
4.2 
2.9 
.8 
.5 
.9 
.2 

173.9 
11.9 
8.6 
5.9 
1.6 
1.1 
1.8 
.5 

Abdominal  tuberculosis  
Pott  's  disease  

White  swellings  

Tuberculosis  of  other  organs 
Disseminated  tuberculosis  .  . 

t  Less  than  .05  per  cent. 

Considered  according  to  organs  or  parts  affected,  tuberculosis  of 
the  lungs  was  the  chief  form  of  the  disease,  accounting  for  84.7% 
of  all  the  deaths  from  tuberculosis.  The  rate  of  mortality  was  173.9 
per  one  hundred  thousand  exposed.  In  the  discussion  of  tubercu- 
losis of  the  lungs  to  follow,  we  shall  accept  the  practice  of  the 
Abridged  International  List  of  Causes  of  Death  and  shall  include 
with  this  form  of  tuberculosis,  the  deaths  from  acute  miliary  tuber- 
culosis, of  which  there  were  6,380  recorded  during  the  six  year 
period  of  this  investigation.  Considering  these  .two  forms  together 
as  tuberculosis  of  the  lungs,  this  disease  was  responsible  for  15.7 
per  cent,  of  the  deaths  from  all  causes  and  90.5  per  cent,  of  the 
deaths  from  all  forms  of  tuberculosis.  A  rate  of  185.7  per  one 
hundred  thousand  exposed  is  registered.  The  only  other  forms  of 
tuberculosis  of  numerical  importance  in  this  mortality  experience 
were  tuberculous  meningitis  and  abdominal  tuberculosis,  which 
assume  considerable  importance  at  certain  periods  of  life. 

The  above  picture  is  a  composite  covering  both  races  and  sexes 
and  all  age  periods  of  life.  Our  very  first  analysis,  however,  indi- 
cates that  this  composite  reduces  itself  into  a  number  of  varying 
elements.  Thus,  we  find  that  the  colored  have  a  much  higher  in- 
cidence than  the  white  policyholders,  that  the  rates  for  the  males 


TUBERCULOSIS. 


46 


exceed  those  for  females,  and  finally,  that  the  figures  for  each 
main  color  and  sex  class  vary  markedly  with  age.  The  first  five 
year  period  of  life  presents  a  comparatively  high  rate.  This  drops 
to  the  minimum  between  5  and  9  years.  With  the  next  period,  10  to 
14  years,  the  figures  mount  again  and  increase  continuously  to 
their  maximum  which  is  attained  between  35  and  44  years,  among 
males  and  somewhat  earlier  among  females.  The  rates  then  de- 
cline rapidly  with  advancing  age.  These  facts  are  presented  in 
the  following  table: 

TABLE  15. 
MOBTALITY  FROM  TUBERCULOSIS,  ALL  FORMS,  CLASSIFIED  BY  COLOR,  SEX 

AND  BY  AGE  PERIOD. 
Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

Whit*. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over      

205.1 

211.9 

147.3 

430.0 

385.1 

1  to  4    

90.7 
37.6 
46.4 
165.0 
287.8 
344.4 
360.4 
279.6 
237.2 
196.0 
177.7 

78.4 
26.3 
19.0 
98.5 
243.8 
385.8 
540.4 
463.5 
365.5 
268.2 
197.2 

76.5 
29.3 
38.5 
144.5 
238.0 
252.2 
215.2 
147.8 
139.1 
140.3 
151.5 

269.2 
135.2 
145.8 
420.7 
584.4 
568.9 
570.1 
465.1 
438.8 
342.4 
315.5 

268.4 
152.5 
277.5 
621.3 
643.9 
488.6 
349.9 
243.9 
198,9 
175.0 
245.0 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  .  .  . 

This  marked  variation  with  age  and  especially  the  presence  of 
two  modal  points  of  incidence,  namely  in  infancy  and  in  adult  life, 
suggest  that  we  are  concerned  with  heterogeneous  material.  In  fact 
we  know  that  the  variations  result  in  large  part  from  the  inclu- 
sion in  our  figures  of  the  several  forms  of  tuberculosis  which 
affect  the  age  periods  very  differently.  It  will  be  more  instructive, 
therefore,  in  our  further  analysis  to  consider  each  of  the  chief  forms 
of  tuberculosis  separately.  We  shall  discuss  first  the  data  for 
tuberculosis  of  the  lungs,  follow  with  tuberculous  meningitis  and 
abdominal  tuberculosis  and  close  with  a  brief  reference  to  the  few 
remaining  titles  included  in  our  main  group. 


46 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


TUBERCULOSIS  OP  THE  LUNGS. 

It  will  be  understood  that  this  title  includes  the  deaths  under 
the  title  as  such  and  also  the  group  of  deaths  assigned  to  acute 
miliary  tuberculosis,  i.  e.,  titles  Nos.  28  and  29  of  the  Interna- 
tional List  together. 

A  total  of  99,906  deaths  is  reported  under  this  head  correspond- 
ing to  a  death  rate  of  185.7  per  100,000  in  the  six  years,  1911  to 
1916.  In  view  of  the  fact  that  90.5%  of  the  total  tuberculosis 
deaths  are  thus  covered,  we  may  expect  that  many  of  the  color,  sex 
and  age  characteristics  observed  for  all  forms  of  tuberculosis  will 
again  be  in  evidence — but  we  shall  note  also  some  variations.  The 
following  table  presents  the  death  rates  per  100,000  exposed  for 
tuberculosis  of  the  lungs,  grouped  according  to  the  color,  sex  and 
age  classes  represented  in  our  data : 

TABLE  16. 

MORTALITY  FROM  TUBERCULOSIS  OP  THE  LUNGS,*  CLASSIFIED  BY  COLOR,  SEX 

AND  BY  AGE  PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.     1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

185.7 

193.7 

131.5 

391.2 

348.5 

1  to  4  

26.3 
16.2 
33.9 
150.5 
273.4 
330.1 
345.4 
267.3 
221.1 
178.7 
156.1 

17.0 

7.7 
9.8 
87.7 
232.9 
373.3 
527.1 
450.6 
345.0 
250.0 
180.2 

18.2 
11.1 
28.5 
133.7 
226.2 
241.2 
203.5 
137.8 
128.5 
126.2 
127.2 

135.2 
79.3 
110.4 
377.8 
547.6 
541.2 
542.7 
444.0 
408.2 
309.0 
301.8 

152.3 
99.1 
232.4 
572.7 
608.0 
461.8 
322.3 
226.1 
175.2 
146.8 
217.8 

5  to  9  

10  to  14  

15  to  19   

20  to  24    

25  to  34      .... 

35  to  44  

45  to  54  

55  to  64  

65  to  74  

/   75  and  over  .  .  . 

*  Includes  ' '  tuberculosis  of  the  lungs, ' '  title  28,  and  ' '  acute  miliary 
tuberculosis, ' '  title  29  of  the  International  List. 

It  will  be  seen  that  the  group  of  colored  persons  in  this  ex- 
perience shows  a  pulmonary  tuberculosis  death  rate  at  all  ages,  one 
and  over,  between  two  and  two  and  one-half  times  that  of  white 


TUBERCULOSIS. 


47 


persons.  Colored  males,  for  instance  have  a  tuberculosis  death 
rate  at  all  ages  which  is  202.0  per  cent,  that  of  white  males;  col- 
ored females  show  a  tuberculosis  death  rate  265.0  per  cent,  that  of 
the  white  female  rate.  These  figures  vary  markedly  when  consid- 
ered by  age;  in  fact,  the  most  instructive  relations  between  the 
two  races  are  thus  brought  to  light.  One  interesting  feature  is  the 
comparatively  early  age  at  which  the  maximum  death  rate  is  found 
among  the  negroes,  namely,  between  20  and  24  years.  Among 
white  males,  Ihe  maximum  is  reached  between  35  and  44  years,  and 
among  white  females,  between  25  and  34  years.  As  will  be  ob- 
served in  the  table  above,  the  mortality  from  tuberculosis  of  the 
lungs  among  colored  males  at  the  age  period  5  to  9  years  is  over 
ten  times  as  great  as  among  white  males  at  that  age.  Between 
the  ages  10  and  14  years,  the  colored  male  rate  for  tuberculosis  of 
the  lungs  is  over  eleven  times  that  for  white  males.  Among  colored 
females  under  15  years  of  age,  the  excess  of  mortality  for  tubercu- 
losis of  the  lungs  over  the  figures  for  white  females  is  also  very 
great,  being  over  eight  times  as  high  in  each  five-year  period.  It  is 
of  more  than  ordinary  interest  to  indicate  that  between  the  ages  45 

TABLE  17. 

MORTALITY  FROM  TUBERCULOSIS  OP  THE  LUNGS.* 
Percentage,  Colored  of  White  Death  Sates  for  Each  Sex,  Classified  ~by  Age 

Period.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Percentage,  Colored  of  White  Mortality. 

Male. 

Female. 

All  ages  —  one  and  over  

202.0 

265.0 

1  to  4  

795.3 
1029.9 
1126.5 
430.8 
235.1 
145.0 
103.0 
98.5 
118.3 
123.6 
167.5 

836.8 
892.8 
815.4 
428.3 
268.8 
191.5 
158.4 
164.1 
136.3 
116.3 
171.2 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34   

35  to  44   

45  to  54  

55  to  64   

65  to  74   

75  and  over  

'Includes   "tuberculosis   of  the  lungs,"   title   28,   and  "acute   miliary 
tuberculosis,"  title  29  of  the  International  List. 


48 


MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


and  54  the  death  rate  from  tuberculosis  of  the  lungs  among  colored 
males  was  slightly  less  than  that  recorded  for  white  males.  The 
maximum  percentage  of  excess  of  colored  mortality  from  tubercu- 
losis of  the  lungs  over  the  figures  for  white  persons  occurred  in  the 
age  period  10  to  14  years  for  males  and  5  to  9  years  for  females. 
There  is  at  present  no  explanation  at  hand  as  to  why  this  ex- 
cess of  colored  over  white  mortality  from  tuberculosis  of  the  lungs 
should  be  so  great  at  the  periods  of  early  life  and  so  much  smaller 
in  later  years. 

The  preceding  table  presents  a  picture  of  the  relative  incidence 
of  pulmonary  tuberculosis  among  white  and  colored  persons. 

The  Death  Rate  of  Pulmonary  Tuberculosis  according  to  Sex. 

The  second  main  classification  of  these  data  will  be  made  ac- 
cording to  sex.  As  is  to  be  noted  in  Table  16,  the  differences  in  the 
rates  of  the  two  sexes  were  very  marked  indeed,  the  degree  of  differ- 
ence varying  somewhat  for  each  of  the  two  races.  The  following 
table  exhibits  the  ratio  of  the  male  to  the  female  death  rate  at 
each  age  period  for  the  two  color  classes  of  this  experience : 

TABLE  18. 

MORTALITY  FBOM  TUBERCULOSIS  OF  THE  LUNGS.* 

Percentage,  Male  of  Female  Death  Sates  for  Each  Color  or  Race  Group, 
Classified  by  Age  Period. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Age  Period. 

Percentage,  Male  of  Female  Mortality-. 

White. 

Colored. 

All  ages  —  one  and  over  

147.3 

112.3 

1  to  4     

93.4 
69.4 
34.4 
65.6 
103.0 
154.8 
259.0 
327.0 
268.5 
198.1 
141.7 

88.8 
80.0 
47.5 
66.0 
90.1 
117.2 
168.4 
190.4 
233.0 
210.5 
138.6 

5  to  9         

10  to  14         

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54       

55  to  64               

65  to  74                   

75  and  over  

*  Includes  ' '  tuberculosis   of   the   lungs, ' '   title   28,   and   ' '  acute   miliary 
tuberculosis,"  title  29  of  the  International  List. 


TUBERCULOSIS.  49 

Considering  all  ages  one  and  over  together,  the  ratio  of  white 
male  to  white  female  mortality  is  147.3,  which  means  an  excess  of 
nearly  one  half.  The  excess  in  the  rate  of  colored  males  over  col- 
ored females  is  only  12.3%.  In  both  races,  however,  the  picture 
is  a  shifting  one  when  we  introduce  the  factor  of  age  period.  Thus 
under  age  20  for  the  whites  and  under  age  25  for  the  colored,  the 
male  rate  for  pulmonary  tuberculosis  is  considerably  lower  than 
that  for  females.  In  fact  between  the  ages  10  and  14  years  the 
rate  for  white  males  is  over  65%  more  favorable  than  that  for  white 
females.  Beginning  with  the  age  period  20  to  24  years,  however, 
mortality  from  tuberculosis  of  the  lungs  among  white  males  is,  at 
every  age  period,  in  excess  of  the  figures  for  white  females.  The 
maximum  percentage  of  difference  is  found  in  the  age  period  45  to 
54  years  where  the  white  male  rate  is  over  3£  times  that  for  the 
white  females.  For  the  group  of  colored  persons,  beginning  with 
the  age  period  25  to  34  years,  the  death  rates  from  tuberculosis  of 
the  lungs  for  males  exceed  those  for  females  in  marked  degree. 
The  percentage  of  male  excess  under  the  age  of  65  is  not  as  great 
for  colored  lives  as  for  white  lives. 

The  figures  themselves  suggest  no  clue  toward  an  explanation  of 
the  remarkable  differences  prevailing  in  the  rates  for  pulmonary 
tuberculosis  among  boys  and  girls  of  both  races.  At  these  younger 
ages,  conditions  of  life  are  very  much  the  same,  and  it  is  difficult 
to  understand  what  factors  can  be  at  work  unless  they  be  the  differ- 
ing inherent  physical  characteristics  of  the  two  sexes. 

The  following  graph  shows  clearly  the  incidence  of  pulmonary 
tuberculosis  in  each  of  the  age  periods  of  our  main  groups,  namely, 
white  males,  white  females,  colored  males  and  colored  females.  It 
will  be  observed  that  the  curves  in  each  instance  show  a  local  maxi- 
mum or  modal  point  at  the  earliest  age  period,  namely,  one  to  four. 
The  lowest  point  is  attained  in  the  next  age  period.  Thereafter, 
a  distinctly  different  contour  is  observed  in  each  of  the  four  curves. 
That  for  white  males  is  the  most  symmetrical  of  all,  showing  one 
modal  point  between  35  and  44  years  of  age.  Colored  males,  on 
the  other  hand,  present  an  asymmetrical  distribution  with  two 
modal  points,  one  at  20  to  24  years  and  the  other  at  35  to  44  years. 
A  further  irregularity  is  observed  at  the  period  55  to  64  years. 
The  curves  for  the  females  are  both  skew,  and  are  also  characterized 
by  the  early  age  at  which  the  maximum  incidence  is  attained.  Of 
5 


50 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


TUBERCULOSIS.  51 

the  two,  the  colored  females  show  a  much  more  symmetrical  distri- 
bution of  the  rates  by  age. 

These  graphs  recall  those  which  Dr.  Brownlee  has  presented  for 
certain  geographical  areas  and  occupation  groups  in  his  analysis 
of  the  incidence  of  pulmonary  tuberculosis  in  Great  Britain.*  Our 
curve  for  white  males  corresponds  very  closely  with  that  for  males 
of  London,  where  the  middle  age  type  of  pulmonary  tuberculosis 
prevails.  The  colored  males,  on  the  other  hand,  present  a  picture 
not  very  different  from  that  described  by  Brownlee  for  Ireland, 
where  the  young  adult  type  of  pulmonary  tuberculosis  prevails. 
This  is  even  more  marked  among  the  colored  females,  where  the 
young  adult  type  prevails  with  very  little  admixture  of  the  middle 
age  type.  The  curve  for  the  white  females  recalls  nothing  in 
the  presentation  by  Dr.  Brownlee  but  seems  to  be  an  admixture 
of  all  three  types.  We  are  not  inclined,  however,  to  consider  these 
graphs  a  verification  of  the  hypothesis  of  Brownlee,  which  was  that 
there  are  three  types  of  tuberculosis;  one  causes  death  among  the 
young,  the  second  affects  middle  ages  chiefly,  the  third  type  affects 
persons  in  old  age.  Our  purpose  is  only  to  show  that  the  same 
conditions  which  that  writer  found  in  Great  Britain  are  repeated 
here,  whatever  may  be  the  ultimate  explanation  for  the  irregular 
distributions  which  are  found  to  characterize  the  death  rates  from 
pulmonary  tuberculosis  in  the  several  color  and  sex  classes. 

Comparison  of  Rates  with  Those  of  the  Expanding  Registration 

Area. 

We  wish  now  to  present  some  comparative  data  for  the  incidence 
of  tuberculosis  of  the  lungs  among  the  group  of  insured  white  wage 
earners  and  the  entire  population  of  the  expanding  Kegistration 
Area  of  the  "United  States.  In  the  first  instance  our  data  relate  to 
observations  in  the  period  1911  to  1916  and  in  the  second  or  popu- 
lation group,  the  period  of  observation  is  1910  to  1915.  This 
minor  difference  in  the  years  covered  by  the  two  studies  does  not 
materially  affect  the  comparison.  The  following  table  gives  the 
death  rates  per  100,000: 

* ' '  Certain  Considerations  Regarding  the  Epidemiology  of  Phthisis  Pul- 
monalis,"  Public  Health,  March,  1916,  London. 


62 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


TABLE  19. 

MORTALITY  FROM  TUBERCULOSIS  OF  THE  LUNGS.* 

Death  Bates  Per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and  Gen- 
eral Population  of  Expanding  Registration  Area  of  the  United 
States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

(White). 

U.  8.  KCR. 
Area. 

Per  Cent. 
M.  L.I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 

M.  L.  I.  CO. 
of  Reg.  Area. 

All  ages  —  one 
and  over  .  . 

193.7 

147.9 

131.0 

131.5 

116.7 

112.7 

1  to  4  

17.0 

24.3 

70.0 

18.2 

23.6 

77.1 

5  to  9  

7.7 

9.8 

78.6 

11.1 

12.7 

87.4 

10  to  14  

9.8 

13.3 

73.7 

28.5 

31.6 

90.2 

15  to  19  

87.7 

81.6 

107.5 

133.7 

116.5 

114.8 

20  to  24  

232.9 

167.6 

139.0 

226.2 

181.2 

124.8 

25  to  34  

373.3 

207.4 

180.0 

241.2 

189.7 

127.1 

35  to  44  

527.1 

237.9 

221.6 

203.5 

153.8 

132.3 

45  to  54  

450.6 

232.2 

194.1 

137.8 

117.2 

117.6 

55  to  64  

345.0 

231.5 

149.0 

128.5 

122.3 

105.1 

65  to  74  

250.0 

205.5 

121.7 

126.2 

147.1 

85.8 

75  and  over.  . 

180.2 

160.0     1 

112.6 

127.2 

140.7 

90.4 

•Includes  "tuberculosis  of  the  lungs,"  title  28,  and  "acute  miliary 
tuberculosis,"  title  29  of  the  International  List. 

The  foregoing  data  indicate  that  among  insured  white  males,  all 
ages  one  and  over,  the  mortality  from  tuberculosis  of  the  lungs 
was  31%  higher  than  among  all  males  of  the  general  popula- 
tion (excluding  under  one  year  of  age).  Females  in  the  families 
of  wage  earners  showed  an  excess  of  only  13%.  It  is  of  the 
greatest  interest,  however,  to  discover  that  in  the  ages  of  child- 
hood, that  is,  under  15,  for  each  sex,  the  death  rate  for  this  con- 
dition was  lower  among  those  in  the  insured  white  group  than 
among  those  in  the  general  population.  The  advantage  in  favor 
of  the  male  children  of  wage  earners  was  even  greater  than 
that  discovered  for  female  children.  Thus  between  the  ages  10 
and  14  years,  the  mortality  rate  from  tuberculosis  of  the  lungs 
among  males  in  the  insured  white  group  was  26.3%  less  than  in 
the  general  population.  The  advantage  in  favor  of  insured  female 
children  for  the  same  age  period  was  only  9.8%  when  compared 
with  the  rate  for  female  children  in  the  general  population.  It  is 
difficult  to  say  to  what  this  favorable  showing  for  pulmonary 


TUBERCULOSIS.  53 

tuberculosis  among  the  insured  may  be  due,  but  two  factors  un- 
doubtedly play  an  important  part.  The  first  is  the  fact  that  we 
are  comparing  white  insured  children  with  a  mixture  of  white  and 
colored  children  in  the  Eegistration  Area.  Although  the  propor- 
tion of  colored  in  this  population  group  is  small,  the  effect  of  their 
inclusion  on  the  tuberculosis  rate  may  be  considerable  because  of 
the  extraordinarily  high  rates  for  this  condition  which  prevail 
among  colored  children.  Unfortunately,  it  is  impossible  to  elim- 
inate the  small  proportion  of  the  colored  from  the  data  of  the  Reg- 
istration Area.  The  second  factor  is  one  of  medical  selection  which 
results  in  eliminating  a  certain  number  of  children  of  obviously 
poor  physique  from  the  insurance  experience.  Such  children 
would  later  appear  in  the  mortality  experience  of  the  Registration 
Area  but  would  not  affect  the  records  of  the  insurance  company. 
It  is  not  possible  to  estimate  at  the  present  time  the  exact  weight 
of  these  two  factors.  But  in  any  case  it  is  a  matter  of  great 
interest  that  the  children  of  wage  earners,  who  reside  in  cities 
and  are  undoubtedly  more  exposed  to  infection  and  to  the  hard- 
ships incident  to  their  economic  stratum,  should  show  no  higher 
rates  from  pulmonary  tuberculosis  than  children  in  the  general 
population,  of  whom  about  one-half  reside  in  rural  areas  where  the 
rate  from  pulmonary  tuberculosis  is  usually  lower  than  in  cities. 

Beginning  with  the  age  period  15  to  19  years  and  continuing  up 
to  age  64  years  for  females  and  up  to  and  beyond  age  75  for  males,- 
the  mortality  rates  for  tuberculosis  of  the  lungs  among  insured 
white  persons  were  greater  than  the  death  rates  for  this  disease 
in  the  general  population  of  the  Registration  Area.  Thus  from  15 
to  19  years  the  rate  for  tuberculosis  of  the  lungs  among  male  wage 
earners  was  7.5%  and  the  rate  among  females  in  wage  earning  fam- 
ilies was  14.8%  in  excess  of  the  corresponding  rates  recorded  at 
the  same  period  in  the  general  population.  Between  20  and  24 
years  of  age,  male  wage  earners  show  an  excess  of  39% ;  between 
25  and  34  years  an  excess  of  80% ;  between  35  and  44  years  an 
excess  of  121.6%.  Among  females  the  excess  of  mortality  from 
tuberculosis  of  the  lungs  among  wage  earners  increases  gradually 
up  to  the  period  35  to  44  years.  Thereafter  the  percentage  of 
excess  mortality  decreases  until  age  65.  In  the  two  highest  age 
periods,  the  insured  white  females  show  lower  death  rates  than 
females  of  the  general  population. 

The  following  table  presents  an  interesting  set  of  ratios  showing 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


the  relative  sex  distribution  of  mortality  from  pulmonary  tuber- 
culosis, by  age,  among  Industrial  policyholders  and  the  population 
of  the  Registration  Area. 

TABLE  20. 

MORTALITY  FBOM  TUBERCULOSIS  OF  THE  LUNGS.* 

Percentage,  Male  of  Female  Death  Bates  Per  100,000  Person*  Exposed. 

Classified  by  Age  Period.     White  Lives,  Experience  of  Metropolitan 

Life   Insurance  Company,   Industrial   Department,   1911    to   1916 

and  General  Population  of  Expanding  Registration  Area  of 

the  United  States,  1910  to  1915. 


Age  Period. 

Percentage.  Male  of  Female  Rate. 

M.  L.  I.  Co.  White  Lives. 
1911  to  1916. 

Kip.  Reg.  Area,  U.  8. 
1910  to  1915. 

All  ages  —  one  and  over  

147.3 

126.7 

1  to  4  

93.4 
69.4 
34.4 
65.6 
103.0 
154.8 
259.0 
327.0 
268.5 
198.1 
141.7 

103.0 
77.2 
42.1 
70.0 
92.5 
109.3 
154.7 
198.1 
189.3 
139.7 
113.7 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

'Includes  "tuberculosis  of  the  lungs,"  title  28,  and  "acute  miliary 
tuberculosis,"  title  2&  of  the  International  List. 

This  table  shows  that  for  the  ages  between  5  and  20  years  males 
show  a  more  favorable  mortality  from  tuberculosis  of  the  lungs 
than  do  females  at  the  same  age  periods.  The  difference  in  favor 
of  insured  males  was  even  greater  than  for  males  in  the  general 
population.  Thus  between  5  and  9  years,  male  mortality  from 
tuberculosis  of  the  lungs  in  wage  earning  families  was  69.4%  of 
the  mortality  among  females ;  the  corresponding  ratio  for  the  gen- 
eral population  was  only  77.2%.  For  the  next  higher  age  period, 
10  to  14  years,  the  advantage  in  favor  of  males  is  even  greater  than 
before.  For  the  insured  experience,  males  had  a  rate  only  34.4% 
of  the  female  rate,  while  for  the  general  population  the  male  rate 
was  42.1%  of  the  female  rate.  Between  15  and  19  years  the  ratio 
for  wage  earning  families  was  65.6%  and  for  the  general  popula- 
tion 70.0%.  It  would  be  interesting  if  we  knew  first,  why  males 
under  20  years  of  age  show  nearly  uniformly  a  lower  mortality  from 


TUBEECULOSIS. 


65 


tuberculosis  of  the  lungs  than  do  females,  and  second,  why  this  ad- 
vantage should  be  more  pronounced  among  male  wage  earners  than 
among  males  in  the  families  of  the  general  population  of  the 
United  States.  Beginning  with  the  age  period  20  to  24  years, 
however,  the  excess  of  male  over  female  mortality  for  tuberculosis 
of  the  lungs  was  greater  in  wage  earning  families  than  in  the  gen- 
eral population  of  the  expanding  Eegistration  Area  of  the  United 
States.  The  foregoing  ratios  suggest  a  number  of  interesting  in- 
quiries for  future  investigation. 

The  Downward  Trend  of  Mortality  from  Tuberculosis  of  the  Lungs. 

In  the  introductory  section  of  this  report,  it  was  pointed  out  that 
the  mortality  experience  of  the  insured  wage  earners  had  declined 
very  appreciably  during  the  six  year  period  covered  by  this  study. 
This  decline  has  been  effected  primarily  through  the  reduction  in 
the  incidence  of  a  number  of  the  more  important  causes  of  death. 
Pulmonary  tuberculosis  is  one  of  these.  In  fact,  the  decline  in  the 
death  rate  from  this  condition  has  been  more  marked  in  this  in- 
surance experience  than  that  from  any  other  single  condition  of  nu- 
merical importance.  The  following  table  is  presented  to  show  the 
trend  of  mortality  for  each  of  the  years  since  1911.  It  will  be  ob- 
served that  the  decline  has  continued  generally  throughout  the  en- 
tire period. 

TABLE  21. 

MORTALITY  FROM  TUBERCULOSIS  OF  THE  LUNGS,*  CLASSIFIED  BY  COLOR  AND 

BY  SEX. 

Death  Eates  Per  100,000  Persons  Exposed.    Single  Tears  in  Period 

1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

185.7 

193.7 

131.5 

391.2 

348.5 

1916  

172.8 
180.0 
185.3 
186.6 
191.6 
203.0 

178.1 

184.0 
197.4 
200.0 
198.2 
210.4 

122.8 
127.3 
127.5 
130.7 
137.3 
148.4 

386.8 
399.9 
396.8 
387.0 
397.3 
378.7 

336.8 
357.0 
347.'8 
328.9 
348.0 
375.1 

1915  

1914  

1913  

1912  

1911  

*  Includes  ' '  tuberculosis   of   the   lungs, ' '   title  28,   and   ' '  acute  miliary 
tuberculosis,"  title  29  of  the  International  List. 


56 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


D««th  Rate 
per  10O.OOO 

400 


Chart  V.— Mortality  from  Tuberculosis  of  the  Lungs 

Do.th    R«te»    per100,OOOP«r»on»    Expomod    By    Single   Years   1911   to   1910 
Eip»rlenc«  ef  Metropolitan  Life  Iniuranco  Company,  Induitrial  Department 


ZOO 


too 


o 

JOH 


White  Mates 

White  FemaJej  -   n  f  -  n  r  n  r.  • 

Colored  Mate 

Co/or  eat  ftmaJej — .  _ , — _ 


/OH 


101S 


J0l6 


TUBERCULOSIS.  57 

The  decline  in  the  death  rate  from  pulmonary  tuberculosis  shown 
in  the  above  table,  especially  for  white  lives,  is  more  pronounced 
than  that  to  be  noted  for  the  general  population  in  the  Eegistration 
Area.  In  fact,  the  acceleration  in  the  decline  of  the  tuberculosis 
rate  among  wage  earners  is  tending  rapidly  to  close  the  gap  which 
still  exists  between  the  death  rates  for  pulmonary  tuberculosis 
among  wage  earners  and  in  the  general  population.  This  is  indi- 
cated by  the  fact  that  in  1911  the  excess  of  the  Metropolitan  rate 
for  white  lives  over  that  for  the  white  mortality  experience  in  the 
Registration  Area  was  40.1%,  whereas  in  1916  this  excess  was  re- 
duced to  33.8%.  Chart  V,  on  page  56,  gives  a  graphic  view  of 
these  facts. 

More  instructive  figures  indicating  the  nature  of  the  decline  in 
the  death  rate  for  pulmonary  tuberculosis  are  those  which  show 
the  conditions  for  each  race  and  sex  at  each  age  period  of  life. 
For  by  this  means,  we  can  localize  the  groups  of  the  insured  where 
the  greatest  improvement  has  occurred,  where  the  improvement  is 
not  so  great,  and  where  no  improvement  has  occurred  at  all.  For 
the  purpose  of  this  comparison  we  shall  take  as  our  starting  point 
the  experience  of  the  two  years  1911  and  1912  combined  and  con- 
trast them  with  the  corresponding  facts  for  the  two  years  1915  and 
1916.  The  variations  which  sometimes  characterize  the  experience 
of  a  single  year  are  in  this  way  reduced.  The  table  on  page  58  pre- 
sents the  ratios  between  the  experience  of  1915  and  1916  combined 
and  that  for  1911  and  1912  combined,  for  each  one  of  the  groups 
which  compose  this  experience. 

The  total  experience  shows  a  reduction  of  10.6%  which  is  a  re- 
markable decrease  for  a  short  period  of  years.  The  most  pro- 
nounced reduction  appears  for  the  group  of  white  females  although 
the  improvement  among  white  males  is  only  slightly  less,  the  per- 
centages of  decline  being  12.4  and  11.3  respectively.  In  the  Reg- 
istration Area  between  1911  and  1915  the  per  cent,  decline  for 
males  was  5.4  and  for  females  10.2.  Among  the  colored  in  the  in- 
sured experience  the  picture  is  not  so  encouraging;  for  among  the 
males  a  slight  increase  in  the  rate  is  found  and  among  the  females 
a  decrease  of  but  4%. 

It  is  difficult  to  observe  any  definite  law  in  the  amount  of  re- 
duction in  the  pulmonary  tuberculosis  rate  in  relation  to  age  groups, 
the  figures  varying  so  with  age  period.  Among  white  lives  there  is 
considerable  improvement  in  the  period  of  childhood  after  age  five 


68 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


TABLE  22. 

MORTALITY  FROM  TUBERCULOSIS  OP  THB  LUNGS.* 

Percentage,  Death  Bate  Per  100,000  Exposed  in  1915-1916  of  Death  Bate  in 
1911-19U  Classified  by  Color,  Sex  and  by  Age  Period. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Percentage,  1915-1910  Rate  of  1911-1912  Rate  In  Specified  Age  Period. 


Age  Period. 

Persona. 

White. 

Colored. 

Male*. 

Females. 

Male*. 

Females. 

All  ages  —  one  and 
over  

89.4 

88.7 

87.6 

101.3 

96.0 

1  to  4  

88.0 
85.5 
93.4 
91.2 
84.3 
85.1 
88.5 
95.6 
97.6 
92.5 
94.5 

101.8 
88.6 
90.5 
78.3 
79.8 
82.5 
89.7 
101.1 
99.0 
98.1 
115.4 

98.9 
94.6 
92.7 
96.6 
87.5 
82.0 
83.2 
89.5 
94.7 
84.2 
73.6 

86.0 

92.7 
103.8 
101.2 
91.6 
101.8 
103.7 
88.9 
106.6 
93.9 
216.5 

88.2 
92.4 
104.4 
102.9 
92.7 
96.5 
87.9 
109.0 
103.5 
112.9 
91.2 

5  to  9  

10  to  14  

15  to  19      

20  to  24  

25  to  34  

35  to  44  

45  to  54      

55  to  64  

65  to  74  

75  and  over  .  .  . 

"Includes  "tuberculosis  of  the  lungs,"  title  28,  and  "acute  miliary 
tuberculosis,"  title  29  of  the  International  List. 

and  in  early  adult  life.  That  is  true  for  both  sexes.  Beginning 
with  age  15  the  improvement  becomes  more  marked  among  white 
males.  In  fact,  the  greatest  reduction  of  any  is  to  be  noted  between 
the  ages  15  and  24  years.  Between  25  and  44  years  favorable 
conditions  are  also  noted  for  both  white  males  and  females.  There- 
after, the  picture  is  very  confusing  with  a  general  indication  of  a 
stationary  death  rate  for  the  years  covered  by  the  study. 

Among  the  colored,  we  find  a  substantial  saving  in  mortality 
under  age  10.  Between  10  and  19  years  the  rates  show  slight  in- 
creases. Between  20  and  25  years  there  is  again  a  noticeable  de- 
crease but  thereafter  the  prevailing  condition  is  one  of  increase 
more  or  less  variable  according  to  age.  On  the  whole,  the  figuies 
among  colored  females  are  more  encouraging  than  those  recorded 
for  colored  males.  But  even  for  this  sex  certain  age  periods,,  such 
as  10  to  14  years  and  45  to  54  years,  show  substantial  increases. 
The  present  condition  of  the  evidence  does  not  allow  safe  prejudg- 
ment  of  the  tendency  of  the  death  rate  among  the  colored.  Per- 


TUBERCULOSIS.  69 

haps  with  the  accumulation  of  data  in  future  years  a  more  definite 
tendency  may  be  established. 

There  is  distinct  cause  for  encouragement  in  the  main  findings 
of  our  inquiry  into  these  facts  of  tuberculosis  mortality  according 
to  age  period.  If  the  rate  of '1911  had  continued  into  1916,  the 
number  of  deaths  from  pulmonary  tuberculosis  among  policy- 
holders  of  this  Company  would  have  been  20,659  instead  of  the  17,590 
which  actually  occurred,  a  saving  of  3,069  lives.  We  have  seen, 
moreover,  that  the  greatest  relative  decline  in  the  tuberculosis 
death  rate  has  occurred  at  those  age  periods  where  the  rates  are 
highest  and  when  life  is  most  valuable  to  the  community. 

The  favorable  aspect  of  this  tuberculosis  experience  in  adult  life 
may  be  the  cumulative  effect  of  all  phases  of  public  health  and  spe- 
cialized anti-tuberculosis  work  of  the  past  twenty  years.  It  is  per- 
haps true  that  the  greatest  results  have  been  obtained  through  pre- 
ventive work  in  behalf  of  children.  Certainly  these  various  efforts 
have  tended  to  increase  the  vital  resistance  of  children  and  have 
also  changed  favorably  the  circumstances  which  control  the  infec- 
tion of  young  people. 

TUBERCULOUS  MENINGITIS. 

This  form  of  the  disease  is  second  only  in  importance  to  pul- 
monary tuberculosis.  Indeed,  in  the  ages  of  childhood  under  age 
10,  tuberculous  meningitis  is  the  chief  form  of  tuberculosis.  In- 
cluded in  this  tabulation  of  deaths  are  fatal  cases  of  tuberculosis 
of  the  brain  and  of  the  cerebrospinal  meninges.  In  all,  4,647  such 
deaths  were  reported  in  the  six  year  period  between  1911  and 
1916.  Of  these  deaths,  2,324  or  fifty  per  cent,  occurred  in  the  age 
period  one  to  four  years.  A  little  more  than  one-fifth  of  the 
cases  were  between  five  and  nine  years  of  age.  Beginning  with 
age  ten,  the  number  of  deaths  is  small,  although  not  unworthy  of 
consideration.  The  table  on  page  60  shows  the  experience  for  tuber- 
culous meningitis  according  to  color,  sex  and  age  class. 

It  should  be  recalled  again  that  the  first  age  period,  one  to  four, 
does  not  include  infants  under  one,  in  which  age  the  highest  death 
rates  from  tuberculous  meningitis  occur.  Thus,  in  the  population 
generally,  between  one-fourth  and  one-fifth  of  all  the  deaths  from 
this  disease  occur  in  the  first  year  of  life.  On  the  other  hand,  the 
death  rate  in  the  second  year  of  life  when  the  insurance  experience 


60 


MORTALITY    STATISTICS   OF   INSURED    WAGE   EARNERS. 


begins  is  not  much  lower  than  in  the  first.  Such  comparisons  as 
we  shall  make  with  the  population  figures  will,  of  course,  be  lim- 
ited to  the  comparable  age  period  over  one  and  under  five  years. 

TABLE  23. 
MORTALITY  FROM  TUBERCULOUS  MENINGITIS,  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AGE  PERIOD. 

Death   Rates   Per   100,000   Persona   Exposed.     1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

8.6 

9.1 

7.7 

11.7 

9.7 

1  to  4  

51.5 
13.8 
5.4 
4.3 
3.4 
2.6 
2.5 
1.5 
1.6 
1.3 
1.4 

48.8 
12.5 
4.5 
3.6 
2.7 
3.0 
3.0 
1.9 
2.1 
.9 
1.4 

49.1 
13.0 
4.9 
4.4 
3.4 
2.0 
1.7 
1.1 
1.0 
1.5 
1.7 

87.8 
26.3 
10.1 
9.9 
7.2 
3.9 
4.2 
1.6 
1.8 
1.7 

83.8 
25.3 
14.6 
4.7 
4.0 
3.1 
3.4 
2.9 
3.1 
1.2 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  .  .  . 

During  the  six  year  period,  deaths  from  tuberculous  meningitis 
were  recorded  at  a  rate  of  8.6  per  one  hundred  thousand  persons  ex- 
posed. This  crude  rate  is  very  low  when  compared  with  the  rate 
for  pulmonary  tuberculosis,  because  the  deaths  are  concentrated 
at  the  early  ages  and  the  exposure  includes  all  ages.  Our  analysis 
will  be  significant,  therefore,  only  as  we  limit  ourselves  to  very 
definite  age  periods,  in  fact,  to  those  under  fifteen;  thereafter, 
tuberculous  meningitis  is  of  no  very  great  account  as  a  cause  of 
death.  The  death  rate  is  highest  for  colored  males  and  least  for 
white  females.  There  is  no  very  marked  difference  between  the 
two  sexes  of  each  color,  although  males  have  a  somewhat  higher 
rate  than  females,  especially  between  twenty-five  and  sixty-five 
years  among  the  whites,  and  fifteen  and  forty-five  years  among  the 
colored.  The  death  rates,  beginning  with  the  maximum  point 
under  five  years  of  age,  decrease  regularly  with  age  up  to  and  in- 
cluding ages  forty-five  to  fifty-four  years.  There  is  a  somewhat 
fluctuating  experience  thereafter.  Practically  the  same  form  of 


TUBEBCULOSIS. 


61 


curve  is  observed  for  each  of  the  color  and  sex  classes  in  this  ex- 
perience. 

A  comparison  of  the  death  rates  for  this  condition  with  those 
prevailing  in  the  Eegistration  Area  should  be  limited  to  the  ages 
under  fifteen,  where  the  death  rates  for  tuberculous  meningitis  are 
really  significant.  Under  age  ten,  the  children  of  white  wage 
earners  show  a  somewhat  higher  mortality  rate  than  do  children  at 
the  same  ages  in  the  population  of  the  expanding  Eegistration 
Area  of  the  United  States.  This  is  true  for  each  sex.  Some 
part  of  the  excess  may  be  due  to  better  registration  of  the  disease 
among  insured  children  than  in  the  general  population.  Our  sys- 
tem of  inquiry  into  causes  of  death  results  in  adding  materially 
to  the  total  number  of  deaths  from  tuberculous  meningitis,  for 
such  reports  as  "meningitis"  are  always  returned  to  physicians  for 
additional  information.  It  should  be  recalled  that  a  net  increase 
of  fourteen  per  cent,  in  the  number  of  deaths  recorded  for  "  tuber- 
culous meningitis"  was  produced  by  this  system  of  inquiry  over 
the  number  which  would  have  been  recorded  had  the  method  of 
querying  physicians  not  been  adopted.  The  age  period  ten  to  four- 
teen years  shows  almost  identical  rates  in  the  population  and  among 
the  insured.  The  following  table  presents  a  comparison  of  the 
death  rates  for  a  few  significant  age  periods  for  insured  lives  as 
well  as  those  of  the  general  population  of  the  expanding  Regis- 
tration Area: 

TABLE  24. 

MORTALITY  FROM  TUBERCULOUS  MENINGITIS. 
Death  Rates  Per  100,000  Persons  Exposed.    Classified  by  Sex  and  by  Age 

Period. 

Insured  White  Lives  in  Experience  of  Metropolitan  Life  Insurance  Com- 
pany, Industrial  Department  (1911  to  1916)  and  General  Population  of 
Expanding  Eegistration  Area  of  the  United  States  (1910  to  1915). 


Age  Period. 

Males. 

Females. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

M.  L.  I.  Co. 

(White). 

U.  S.  Reg. 
Area. 

1  to  4  

48.8 
12.5 
4.5 

41.9 

10.8 
4.5 

49.1 
13.0 

4.9 

40.0 
10.7 
5.0 

5to9  

10  to  14  

Like  pulmonary  tuberculosis,  tuberculous  meningitis  shows  a 
very  favorable  trend  in  its  incidence  during  recent  years.  In  the 
age  period  one  to  four  years  the  rate  for  white  males  for  the  two 


62 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


years  1911  and  1912  was  51.5  and,  for  1915  and  1916  combined,  it 
was  only  46.0  per  one  hundred  thousand.  The  per  cent,  decline 
was,  therefore,  10.7.  The  greatest  decline  among  the  insured  ap- 
pears to  have  occured  among  white  females,  where  the  rate  for 
1915  and  1916  was  18.0  per  cent,  lower  than  that  for  1911  and  1912 
combined. 

ABDOMINAL  TUBERCULOSIS. 

Abdominal  tuberculosis  is  the  third  form  of  tuberculous  disease 
of  interest  in  this  discussion.  We  have  included  in  our  figures 
deaths  from  tuberculosis  of  the  gastroenteric  tract,  including  the 
peritoneum,  the  omentum  and  the  mesenteric  glands.  In  all,  there 
were  3,155  such  deaths.  Deaths  from  this  disease  seem  to  be  fairly 
well  distributed  over  the  entire  range  of  life.  The  variation  in  the 
death  rate  from  one  age  period  to  another  is  not  so  marked  as  was 
observed  for  pulmonary  tuberculosis  or  for  tuberculous  meningitis. 
There  appear  to  be  in  this  present  series  of  data  three  points  of 
modal  incidence,  the  first  at  the  age  period  one  to  four  years,  the 
second  in  the  age  period  35  to  44  years  and  the  third  after  age  75. 
Between  each  of  these  points  the  curve  tends  to  assume  a  concave 
form.  The  least  rate  was  registered  in  the  age  period  ten  to  four- 
teen years.  Our  facts  according  to  color,  sex  and  age  period  are 
displayed  in  the  following  table: 

TABLE  25. 
MORTALITY  FROM  ABDOMINAL  TUBERCULOSIS,  CLASSIFIED  BY  COLOR,  SEX  AND 

AGE  PERIOD. 

Death  Bates   Per   100,000   Persons   Exposed.    1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Person*. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females 

All  ages  —  one  and 
over  

5.9 

3.7 

4.6 

15.4 

19.6 

1  to  4      

6.8 
3.4 
3.2 
5.3 
6.4 
6.7 
7.9 
6.3 
7.6 
8.4 
10.6 

6.2 
2.2 
1.1 
2.2 
3.2 
3.9 
5.2 
5.4 
7.7 
8.4 
8.5 

5.2 
2.1 
2.3 
3.4 
5.3 
5.1 
6.5 
5.5 
5.9 
7.7 
11.7 

28.2 
16.9 
14.2 
19.8 
17.1 
13.4 
13.8 
10.7 
16.2 
6.7 

14.6 
18.2 
21.1 
32.8 
23.8 
19.8 
18.6 
11.3 
13.6 
16.4 
18.1 

5  to  9    

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  .  .  . 

TUBERCULOSIS. 


63 


The  colored  show  higher  death  rates  in  this  series  than  do  the 
whites,  and  the  rate  for  females  of  each  color  group  exceeds  that 
for  the  males. 

Among  white  lives,  there  is  no  great  difference  between  the  rates 
of  the  two  sexes  under  ten  years  of  age.  Beginning  with  the  age 
period  ten  to  fourteen  years,  however,  the  death  rates  for  abdominal 
tuberculosis  among  white  females  begin  to  exceed  the  rates  for  white 
males  to  a  significant  extent,  up  to  and  including  the  period  thirty- 
five  to  forty-four  years.  This  suggests  the  influence  of  puerperal 
traumata  as  causes  contributing  to  the  development  of  abdominal 
tuberculosis.  For  the  period  forty-five  to  fifty-four  years,  the  rates 
for  both  sexes  for  white  lives  are  approximately  the  same.  After 
fifty-five  years  of  age,  the  figures  for  white  males  exceed  those  for 
white  females  up  to  and  including  age  seventy-four. 

White  males  and  white  females  show  in  general  a  decreasing 
death  rate  from  abdominal  tuberculosis  in  this  experience.  Col- 
ored males,  however,  show  a  variable  rate  with  no  definite  tendency 
in  either  an  upward  or  downward  direction.  There  seems  to  be 
only  a  slight  downward  tendency  in  the  death  rate  from  abdominal 
tuberculosis  among  colored  females.  These  facts  are  displayed  in 
the  following  table: 

TABLE  26. 

MORTALITY  FROM  ABDOMINAL  TUBERCULOSIS,  CLASSIFIED  BY  COLOR  AND 

BY  SEX. 
Death  Bates  Per  100,000  Persons  Exposed.     Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

5.9 

3.7 

4.6 

15.4 

19.6 

1916  . 

5.1 
5.2 
5.5 
6.2 
6.6 
6.9 

3.2 
3.3 
2.9 
3.7 
4.8 
4.6 

3.7 
4.0 
4.6 
5.1 

4.8 
5.8 

15.3 
14.5 
14.3 
17.1 
17.0 
14.3 

18.4 
18.6 
20.0 
19.2 
20.6 
21.1 

1915  

1914  

1913  

1912  

1911  

Comparison  of  the  death  rates  for  abdominal  tuberculosis  among 
white  insured  persons  and  among  persons  in  the  Eegistration  Area 
shows  some  items  of  interest.  These  are  displayed  in  the  following 
table: 


64 


MORTALITY    STATISTICS   OF   INSURED    WAGE   EARNERS. 


TABLE  27. 

MORTALITY  FBOM  ABDOMINAL  TUBERCULOSIS. 

Death  Rates  Per  100,000  Persons  Exposed.    Classified  by  Sex  and  by  Age. 

Insured  White  Lives  in  Experience  of  Metropolitan  Life  Insurance  Company, 

Industrial  Department  (1911  to  1916)  and  General  Population  of 

Expanding  Registration  Area  of  the  United  States 

(1910  to  1915). 


Male*. 

Females. 

Ate  Period. 

M.  L.  I.  Co. 

(White). 

U.  S.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 

of  Reg.  Area. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 

of  Reg.  Area. 

All  ages  —  one 
and  over  .  . 

3.7 

4.8 

77.1 

4.6 

6.0 

76.7 

1  to  4  

6.2 

6.9 

89.9 

5.2 

5.3 

98.1 

5  to  9  

2.2 

2.7 

81.5 

2.1 

2.2 

95.5 

10  to  14  

1.1 

1.9 

57.9 

2.3 

2.6 

88.5 

15  to  19  

2.2 

3.3 

66.7 

3.4 

5.1 

66.7 

20  to  24  

3.2 

4.4 

72.7 

5.3 

6.9 

76.8 

25  to  34  

3.9 

4.6 

84.8 

5.1 

7.2 

70.8 

35  to  44  

5.2 

4.9 

106.1 

6.5 

7.0 

92.9 

45  to  54  

5.4 

5.6 

96.4 

5.5 

6.9 

79.7 

55  to  64  

7.7 

8.4 

91.7 

5.9 

9.1 

64.8 

65  to  74  

8.4 

10.4 

80.8 

7.7 

10.4 

74.0 

75  and  over.  . 

8.5 

7.6 

111.8 

11.7 

10.6 

110.4 

It  is  a  matter  of  great  interest  that  the  male  mortality  for  the 
general  population  of  the  Eegistration  Area  exceeds  that  for  white 
males  in  the  insurance  experience.  The  only  exception  is  in  the 
age  group  35  to  44  years  and  beyond  age  75.  Among  females, 
the  population  rates  are  in  excess  of  those  for  the  insurance  ex- 
perience for  all  age  periods  except  75  years  and  over.  The  least 
ratio  of  excess  is  to  be  observed  in  the  age  period  1  to  4  years. 

TUBERCULOSIS  OF  OTHER  FORMS,  AND  DISSEMINATED  TUBER- 
CULOSIS. 

We  did  not  deem  it  desirable  to  bring  out  in  any  great  detail 
the  facts  for  the  remaining  forms  of  tuberculosis  registered  in  our 
mortality  records.  In  addition  to  mortality  from  the  forms  of 
tuberculosis  which  have  been  discussed  in  the  preceding  sections, 
we  recorded  2,655  deaths  from  tuberculous  infection  of  other  or- 
gans. These  deaths  occurred  at  a  rate  of  4.9  per  100,000  exposed. 
According  to  our  records,  there  was  a  gradual  decrease  in  deaths 
from  these  miscellaneous  forms  of  tuberculosis,  from  a  rate  of  5.8 
per  100,000  in  1911  to  a  rate  of  4.1  in  1916. 


CHAPTEE  V. 

ORGANIC  DISEASES  OF  THE  HEABT. 

The  deaths  classified  as  due  to  "organic  diseases  of  the  heart" 
form  a  group  which  is  second  in  numerical  importance  only  to 
tuberculosis  in  this  mortality  experience  of  insured  wage  earners. 
In  the  experience  of  the  general  population  of  the  expanding  Eeg- 
istration  Area  in  recent  years,  organic  heart  disease  has  ranked 
first  as  a  cause  of  death.  During  the  six-year  period,  1911  to  1916, 
75,345  deaths  from  organic  cardiac  diseases  were  recorded  among 
the  Company's  Industrial  policyholders.  This  number  is  11.9  per 
cent,  of  the  635,449  deaths  from  all  causes.  The  deaths  corre- 
spond to  a  rate  of  140.1  per  100,000  exposed.  This  is  for  the  en- 
tire experience  period;  but  in  four  of  the  six  years  the  rate  was 
higher  than  that  for  the  period  as  a  whole. 

The  chief  interest  in  connection  with  the  study  of  the  mortality 
from  cardiac  disease  lies,  of  course,  in  its  variable  age,  color  and 
sex  incidence.  The  disease  is  primarily  one  of  advanced  life, 
although,  as  we  shall  see,  it  takes  a  significant  toll  at  the  younger 
adult  ages.  The  rate  is  considerably  higher  among  colored  persons 
than  among  the  white  group,  which  condition  also  obtained  in  the 
Registration  Area  for  the  period  as  a  whole  and  for  each  included 
year.  This  was  true  for  each  sex  for  every  significant  age  group 
with  the  exception  of  that  relating  to  decedents  75  years  of  age 
and  over. 

The  death  rates  are  very  different  for  the  two  sexes.  Almost 
without  exception  the  rates  for  females  are  higher  than  for  males 
up  to  and  including  the  age  period  20  to  24  years.  After  this  age 
period,  however,  the  situation  is  reversed,  the  death  rates  for  males 
being  very  much  higher  than  for  females.  This  is  uniformly  true 
for  white  lives  but  there  are  a  few  exceptions  among  the  colored.  It 
would  appear,  therefore,  that  these  organic  heart  diseases  in  their 
higher  incidence  among  adult  males  strike  heavily  at  the  chief  or 
only  income jyrndYir'prs  of  families ;  ^ftpn  after  long  periods  of  sick- 
ness in  which  the  wage  earner  has  been  unable  to  work  actively  all 
or  part  of  the  time.  These  diseases  thus  bring  about  hardship  and 
6  65 


66 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


distress  which  can  not  be  shown  in  figures.  In  fact,  if  it  were  pos- 
sible to  calculate  the  money  loss  to  the  country  through  deaths  from 
the  heart  affections  and  the  long  periods  of  sickness  which  precede 
them,  the  importance  of  cardiac  disease  economically  would  be 
much  more  impressively  demonstrated  than  is  possible  by  the  publi- 
cation of  mere  numbers  of  deaths  and  the  corresponding  death 
rates. 

Considered  irrespective  of  color  or  sex,  we  find  that  the  death 
rates  for  the  organic  diseases  of  the  heart  increase  regularly  with 
age,  but  show  their  greatest  increases  in  the  higher  age  periods. 
This  is  brought  out  clearly  in  the  following  table  and  in  the  ac- 
companying graph : 

TABLE  29. 

MORTALITY  FROM  ORGANIC  DISEASES  OF  THE  HEART,  CLASSIFIED  BY  COLOR, 
SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

WWte. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one    and 
over  

140.1 

125.9 

137.0 

191.0 

202.0 

1  to  4  

7.3 
16.2 
'   26.7 
30.2 
30.6 
53.5 
121.8 
253.6 
604.8 
1523.1 
2808.1 

7.0 
14.9 
22.7 
28.7 
28.5 
51.6 
120.1 
259.0 
641.2 
1624.2 
3033.1 

6.4 
18.2 
31.4 
31.2 
30.4 
45.6 
92.6 
201.1 
526.8 
1443.0 
2703.1 

14.1 
11.4 
19.9 
29.4 
32.2 
89.6 
201.2 
416.0 
885.4 
1702.2 
2647.8 

14.6 
14.1 
28.3 
34.9 
42.8 
72.8 
211.7 
433.1 
787.8 
1530.3 
2613.2 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

Significant  relations  may  be  brought  out  by  comparing  the  fore- 
going figures  for  white  persons  with  those  for  the  total  expanding 
Eegistration  Area  of  the  United  States.  We  shall  use  for  this  pur- 
pose the  population  figures  for  the  six  year  period  1910  to  1915 
inclusive.  Taking  all  ages  one  and  over  together  in  the  two  expe- 
riences, we  find  that  the  mortality  rate  for  insured  white  males 
(125.9  per  100,000)  was  lower  than  that  for  males  of  the  Registra- 
tion Area  (147.0  per  100,000)  and  that  the  rate  for  insured  white 


ORGANIC   DISEASES   OF  THE   HEART. 


67 


I-  S 


s 

I-    • 


M)     o 

B  • 

a? 

to  • 
5 


1 

OC  IL 
0 


O  " 

I! 

I 

O   8 


4> 


68 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


females  (137.0)  was  lower  than  the  rate  for  females  in  the  general 
population  (140.7).  No  mistake  should  be  made,  however,  as  to 
the  meaning  of  these  figures.  The  apparent  advantage  in  favor  of 
the  insured  group  results  simply  from  their  more  favorable  age 
distribution.  A  larger  proportion  of  them  are  in  the  younger  age 
groups  where  the  death  rate  from  the  heart  diseases  is  low,  and 
only  a  small  proportion  of  the  policyholders  are  found  in  the  ad- 
vanced ages  when  the  death  rate  from  these  conditions  is  very  high. 
A  comparison  between  the  two  series  must,  therefore,  be  strictly 
limited  to  each  age  period  and  to  each  of  the  sex  groups,  separately. 
The  following  table  shows,  side  by  side,  the  figures  for  males  in 
the  expanding  Registration  Area  compared  with  those  for  insured 
white  males  and  for  females  in  the  Registration  Area  compared 
with  insured  white  females : 

TABLE  30. 

MORTALITY  FROM  ORGANIC  DISEASES  or  THE  HEART. 

Death  Rates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Percentage 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  S.  Reg. 

Percentage 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

125.9 

147.0 

85.6 

137.0 

140.7 

97.4 

1  to  4.... 

7.0 

7.6 

92.1 

6.4 

7.6 

84.2 

5  to  9.... 

14.9 

12.6 

118.3 

18.2 

15.3 

119.0 

10  to  14... 

22.7 

16.6 

136.7 

31.4 

21.2 

148.1 

15  to  19... 

28.7 

19.7 

145.7 

31.2 

20.4 

152.9 

20  to  24... 

28.5 

20.0 

142.5 

30.4 

23.0 

132.2 

25  to  34... 

51.6 

33.4 

154.5 

45.6 

36.9 

123.6 

35  to  44... 

120.1 

76.0 

158.0 

92.6 

76.8 

120.6 

45  to  54... 

259.0 

175.5 

147.6 

201.1 

160.9 

125.0 

55  to  64... 

641.2 

474.4 

135.2 

526.8 

409.2 

128.7 

65  to  74... 

1624.2 

1213.8 

133.8 

1443.0 

1044.1 

138.2 

75  and  over 

3033.1 

2665.6 

113.8 

2703.1 

2438.6 

110.8 

Thus  compared,  a  very  different  picture  is  presented,  for,  with 
the  single  exception  of  the  period  of  early  childhood,  namely,  1  to 
4  years,  the  death  rates  are  much  higher  for  the  insured  group  than 


ORGANIC   DISEASES    OF   THE    HEART.  69 

for  the  general  population.  It  is  especially  at  the  working  ages  of 
life  that  the  disadvantage  of  the  policyholders  is  evident.  The  facts 
of  mortality  from  organic  diseases  of  the  heart,  as  for  tuberculosis, 
show  with  advancing  age  the  cumulative  effect  upon  the  vitality  of 
wage  earners  of  more  severe  conditions  of  life  and  work,  and  per- 
haps of  less  favorable  hygienic  circumstances,  than  are  found  in 
the  general  population  of  the  United  States. 

This  conclusion  is  apparently  substantiated  when  we  compare 
the  relation  between  the  death  rates  of  the  two  sexes  in  the  popula- 
tion and  in  the  insured  group.  We  find,  for  example,  in  the  twenty 
year  age  period,  from  25  to  45  years,  very  much  higher  rates  for 
males  than  for  females  in  the  wage  earning  element.  On  the  other 
hand,  in  the  general  population,  females  at  these  ages  do  not  enjoy 
any  such  advantage ;  in  fact,  the  rates  are  slightly  higher  for  them 
than  for  the  males.  This  would  seem  to  be  the  result  of  the  severer 
strain  of  life  and  work  to  which  male  wage  earners  are  exposed. 

The  trend  of  the  death  rate  from  organic  heart  diseases  in  the 
Industrial  Department  of  the  Metropolitan  Life  Insurance  Com- 
pany during  the  six  years  is  interesting. and  is  in  marked  contrast 
with  the  tendency  shown  by  the  figures  of  the  general  population. 
In  the  insurance  figures  the  rate  for  1916  is  lower  than  for  1911 
(140.2  as  compared  with  141.8).  This  represents  a  decline  of  1.1 
per  cent,  in  the  period.  On  the  other  hand,  in  the  expanding  Reg- 
istration Area  the  figures  show  a  very  considerable  increase  in  the 
six  year  period  from  140.9  in  1911  to  150.1  per  100,000  in  1916 
(6.5  per  cent.).  It  is  quite  true  that  in  both  experiences  there  is 
a  certain  irregularity  in  the  trend;  but  the  rates  for  the  insured 
group,  very  generally  speaking,  show  downward  tendency,  whereas 
those  for  the  population,  especially  since  1913,  show  a  continuous 
rise.  The  changes  that  have  occurred  in  the  population  figures  are 
even  more  strikingly  brought  out  when  we  go  back  a  number  of 
additional  years.  In  1900  the  Registration  Area  rate  was  only 
111.2  per  100,000;  by  1904  it  had,  through  continuous  increases, 
reached  133.4.  From  that  year  until  1911  there  was  considerable 
fluctuation;  the  1911  rate  (140.9)  marked  a  26.7  per  cent,  increase 
over  the  figure  for  1900. 

The  following  table  presents  the  trend  of  mortality  among  in- 
sured wage  earners  in  the  years  1911  to  1916: 


70 


MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


TABLE  31. 

MORTALITY  PROM  ORGANIC  DISEASES  or  THE  HEART,  CLASSIFIED  BY  COLOR 

AND  BY  SEX. 

Death  Sates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona. 

White. 

Colored. 

Male*. 

Females. 

Males. 

Females. 

1911  to  1916 

1916. 

1915. 
1914. 
1913. 
1912. 
1911. 

140.1 

125.9 

137.0 

191.0 

202.0 

140.2 
136.7 
138.1 
140.6 
143.8 
141.8 

126.0 
119.4 
125.5 
127.3 
129.4 
128.8 

135.8 
136.1 
134.6 
137.2 
139.5 
139.9 

197.2 
183.9 
191.5 
194.6 
202.6 
175.5 

212.9 
207.1 
193.1 
193.9 
205.7 
19S.7 

The  increase  in  mortality  from  organic  heart  diseases  which  we 
have  just  discussed  for  the  Eegistration  Area  has,  in  recent  years, 
given  rise  to  the  prevalent  opinion  that  there  has  been  a  marked 
increase  in  the  so-called  "degenerative  diseases."  Certainly  this 
conclusion  is  not  substantiated  by  the  facts  presented  by  the  mor- 
tality data  for  insured  wage-earners.  If,  however,  we  limit  our- 
selves to  a  consideration  of  the  expanding  Registration  Area  alone, 
we  should  keep  in  mind  that  even  these  data  with  their  marked  in- 
creases in  the  interval  since  1900  must  not  be  taken  on  their  face 
as  final.  The  Census  Bureau  itself  has  continually  cautioned  the 
readers  of  its  reports  on  Mortality  Statistics  against  comparing  the 
more  recent  figures  for  organic  diseases  of  the  heart  with  those  run- 
ning prior  to  1910.  Very  important  changes  in  the  statistical 
treatment  of  this  return  of  cause  of  death  have  been  instituted  by 
the  Census  Bureau.  Certain  statements  of  cause,  such  as,  "  endo- 
carditis" and  "myocarditis"  for  decedents  over  60  years  of  age 
which  were  formerly  excluded  from  this  title  are  now  classified 
under  it.  Methods  of  treating  jointly  reported  causes  of  death  as 
well  as  the  accelerated  tendency  of  physicians  to  report  more  defi- 
nitely the  conditions  causing  death,  have  undoubtedly  resulted  in 
the  increased  reporting  of  organic  diseases  of  the  heart.  The  evi- 
dence, therefore,  is  clear  that  a  large  part,  at  least,  of  the  increase 
in  the  death  rate  of  the  heart  diseases  is  fictitious,  resulting  merely 


ORGANIC  DISEASES   OF   THE  HEART.  71 

from  changed  reporting  and  compiling  procedure;  and  so  far  as 
this  concerns  insured  wage  earners  where  the  greatest  amount  of 
increase  might  be  expected,  it  does  not  show  at  all. 

Organic  diseases  of  the  heart,  International  List  title  No.  79,  as 
compiled  in  this  report,  include  all  chronic  valvular  diseases,  fatty 
degeneration,  chronic  myocarditis  and  chronic  dilatation.  It  in- 
cludes a  number  of  deaths  which  are  ascribed  by  physicians  to 
"heart  disease"  without  further  definition.  It  also  comprehends 
chronic  heart  diseases  of  rheumatic  origin.  On  the  other  hand,  the 
title  does  not  include  acute  endocarditis,  acute  myocarditis,  "  endo- 
carditis "  or  "  myocarditis  "  with  no  further  qualification,  for  dece- 
dents under  60  years  of  age.  Deaths  reported  as  due  to  pericar- 
ditis and  those  reported  as  due  to  many  indeterminate  cardiac 
symptoms  such  as  "palpitation  of  the  heart,"  "functional  disease 
of  the  heart "  and  others  are  not  included. 


CHAPTER  VI. 


PNEUMONIA  (ALL  FORMS). 

Pneumonia,  as  the  term  is  popularly  used,  is  a  most  important 
cause  of  death  in  this  experience,  the  incidence  of  which  has  been 
increasing  significantly  during  recent  years.  Unfortunately,  the 
term  has  no  great  scientific  value  since  it  is  used,  in  the  main,  to 
cover  two  very  different  conditions,  namely,  lobar  pneumonia  and 
bronchopneumonia.  Lobar  pneumonia  is  a  disease  affecting,  for 
the  most  part,  the  adult  ages  of  life.  Bronchopneumonia,  on  the 
other  hand,  is  a  disease  affecting  chiefly  the  periods  of  childhood 
and  old  age.  In  fact,  two-thirds  of  all  the  deaths  in  the  general 
population  experience  from  bronchopneumonia  are  those  of  chil- 
dren under  five  years  of  age.  For  these  reasons  and  because  of  the 
different  clinical  pictures  presented  by  these  two  conditions,  it  will 
be  much  more  instructive  to  treat  in  detail  each  of  the  types  of 
pneumonia  separately.  At  this  point  it  is  necessary  only  to  remark 
that  in  the  period  between  1911  and  1916  the  total  number  of 
deaths  from  "pneumonia  (all  forms)  "  was  57,931 ;  this  is  the  total 
for  lobar  pneumonia,  so  defined,  bronchopneumonia  and  "pneu- 
monia" without  further  qualification.  Together  the  death  rate 

TABLE  32. 

MOBTALITY   FROM   PNEUMONIA    (ALL   FORMS),   PNEUMONIA    (LOBAR   AND   UN- 
DEFINED)  AND  BRONCHOPNEUMONIA. 

Death  Bates  per  100,000  Persons  Exposed.     Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

"  Pneumonia  (All 
Forms)." 

Pneumonia  (Lobar  and 
Undefined)  . 

Bronchopneumonia. 

1911  to  1916  

107.7 

77.5 

30.2 

1916   

114.3 

80.8 

33.5 

1915      .... 

106.5 

744 

32  1 

1914  

100.3 

68.9 

31.4 

1913  

106.1 

77.7 

28.4 

1912  

103.9 

75.8 

28.1 

1911  

115.3 

89.2 

26.1 

72 


PNEUMONIA.  73 

for  the  six  year  period  was  107.7  per  100,000  exposed.  The  preced- 
ing figures  show  the  trend  in  the  rate  for  this  large  group  of  causes 
of  death  since  1911. 

(a)  PNEUMONIA  (LOBAR  AND  UNDEFINED). 

Statistics  of  mortality  from  pneumonia  (lobar  and  undefined) 
are  interesting  from  many  standpoints.  Lobar  pneumonia  is  the 
most  important  numerically  of  the  infectious  diseases.  It  kills 
every  year  more  people  than  die  of  such  infectious  diseases  as 
measles,  scarlet  fever,  diphtheria,  whooping  cough  and  acute  polio- 
myelitis combined.  Any  one  stricken  with  lobar  pneumonia,  more- 
over, has  a  smaller  chance  of  recovery  than  have  those  afflicted 
with  any  one  of  the  other  conditions  just  mentioned — even  polio- 
myelitis or  "infantile  paralysis."  Several  health  departments 
have,  therefore,  placed  lobar  pneumonia  on  the  list  of  reportable 
diseases,  thus  officially  recognizing  the  fact  of  its  infectiousness  and 
calling  attention  to  its  extremely  fatal  nature. 

During  the  six-year  period  1911  to  1916,  in  this  experience, 
41,707  insured  wage  earners  and  members  of  their  families  died 
of  pneumonia  (lobar  and  undefined).  The  death  rate  correspond- 
ing to  this  number  of  deaths  was  77.5  per  100,000.  This  group 
of  diseases  shows  a  higher  death  rate  among  colored  policyholders 
than  among  the  white.  The  table  on  page  74  shows  also  that 
these  facts  are  true  both  for  males  and  females.  The  ages  of  high- 
est mortality  are  the  extremes  of  life.  This  applies  to  both  white 
and  colored  persons  and  to  males  and  females.  The  excess  of  col- 
ored over  white  mortality  is  shown  in  every  age  period  for  both 
males  and  females. 

Further  consideration  of  this  table  shows  that  the  rate  for  males 
is  almost  uniformly  higher  than  that  for  females.  There  are,  to 
be  sure,  two  exceptions  among  white  lives,  one  at  ages  10  to  14 
years,  the  other  at  the  very  advanced  age  period  75  years  and  over, 
but  in  both  cases  the  difference  between  the  two  sexes  is  slight  and 
does  not  materially  affect  the  conclusion  drawn.  Beginning  with 
the  period  25  to  34  years  and  continuing  up  to  65  to  74  years,  the 
rate  for  males  is  much  in  excess  over  the  rate  for  females ;  in  fact, 
for  a  number  of  these  age  periods  the  rate  for  males  is  more  than 
twice  that  of  females.  Much  the  same  conclusion  may  be  drawn 
from  the  comparison  of  the  rates  for  the  two  sexes  of  the  insured 


74 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


TABLE  33. 
MORTALITY   FROM   PNEUMONIA    (LOBAR   AND   UNDEFINED),   CLASSIFIED   BY 

COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one 
and  over  

77.5 

82.6 

63.0 

141.5 

97.2 

1  to  4  

108.0 
19.7 
11.5 
20.8 
29.5 
50.1 
89.7 
139.6 
247.9 
468.7 
791.3 

103.5 

17.9 
9.5 
19.4 
29.0 
62.6 
130.9 
197.4 
300.7 
500.0 
774.6 

93.2 
17.5 
10.8 
14.6 
17.9 
29.4 
50.8 
92.7 
203.3 
441.1 
794.4 

240.4 
32.8 
22.8 
52.4 
94.0 
119.8 
175.2 
242.7 
346.4 
542.9 
836.9 

232.2 
47.6 
24.9 
51.8 
60.5 
55.8 
86.2 
126.9 
251.8 
482.7 
834.8 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

colored  group,  although  the  differences  are  not,  on  the  whole,  as 
great  as  those  observed  among  the  whites.  The  charts  on  page 
75  graphically  illustrate  these  facts  for  pneumonia  mortality  ac- 
cording to  age. 

The  rate  already  noted  for  the  entire  experience,  namely,  77.5 
per  100,000,  is  somewhat  more  favorable  than  that  found  in  the 
expanding  Registration  Area  of  the  United  States  for  the  six-year 
period  1910  to  1915.  This  condition  is  still  in  evidence  when  the 
estimated  population  of  the  Area  under  one  year  of  age  is  elimi- 
nated, and  the  rates  are  computed  for  persons  of  the  same  age 
groups  as  those  covered  by  the  insurance  experience.  Thus,  we 
find  that  in  the  six-year  period  1910  to  1915  the  population  rate  for 
males  was  84.3  per  100,000,  while  the  rate  for  females  was  66.6. 
These  compare  with  the  policyholders'  figures  of  82.6  and  63.0 
for  insured  white  males  and  white  females  respectively.  The  gen- 
eral population  figures  would  be  somewhat  lower  if  it  were  possible 
to  eliminate  the  effect  of  the  colored  element  which  is  included. 
This  cannot  be  done  but  it  is  evident  that  the  exposures  in  the  two 
experiences  are,  by  and  large,  in  very  close  agreement. 

An  analysis  by  age  groups  shows,  however,  a  number  of  impor- 
tant points  of  difference  when  we  compare  the  experience  in  the 


PNEUMONIA. 


75 


76 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


general  population  with  that  of  the  insured.  We  find,  for  example, 
that  for  males,  the  general  population  rates  are  somewhat  higher 
until  central  age  22.5  is  reached.  At  this  point  there  is  a  sharp 
upward  trend  in  the  experiences — much  more  pronounced,  how- 
ever, among  white  male  policyholders  than  in  the  general  popula- 
tion— so  much  so  that  the  rate  in  the  next  age  period  for  white 
male  policyholders  is  considerably  in  excess  of  that  for  males  in 
the  general  population.  Comparing  females,  we  find  that  white 
female  policyholders  enjoyed  an  advantage  up  to  and  including 
the  age  period  20  to  24  years.  Thereafter  they  show,  without 
exception,  higher  rates,  although  the  differences  are  not  as  great 
as  those  we  recounted  for  the  males. 

In  both  experiences- the  age  group  of  maximum  mortality  is  the 
period  75  years  and  over  and  the  minimum  mortality  occurs  in  the 
age  period  10  to  14  years.  The  following  table  presents  the  facts 
by  sex  and  age  period  for  the  expanding  Registration  Area  with- 
out distinction  of  color,  and  for  white  males  and  white  females  in- 
sured in  the  Industrial  Department  of  the  Company: 

TABLE  34. 
MORTALITY  FROM  PNEUMONIA  (LOBAR  AND  UNDEFINED). 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  CO. 

(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

82.6 

84.3 

98.0 

63.0 

66.6 

94.6 

Ito4.... 

103.5 

110.4 

93.8 

93.2 

97.3 

g&8 

5  to  9.... 

17.9 

19.5 

91.8 

17.5 

17.8 

98.3 

10  to  14... 

9.5 

11.4 

83.3 

10.8 

12.0 

90.0 

15  to  19... 

19.4 

24.6 

78.9 

14.6 

16.1 

90.7 

20  to  24... 

29.0 

33.1 

87.6 

17.9 

19.9 

89.9 

25  to  34.  .  . 

62.6 

46.2 

135.5 

29.4 

29.0 

101.4 

35  to  44... 

130.9 

81.7 

160.2 

50.8 

43.7 

116.2 

45  to  54... 

197.4 

127.4 

154.9 

92.7 

73.7 

125.8 

55  to  64... 

300.7 

204.4 

147.1 

203.3 

155.6 

130.7 

65  to  74... 

500.0 

344.9 

145.0 

441.1 

336.2 

131.2 

75  and  over 

774.6 

701.0 

110.5 

794.4 

785.8 

101.1 

PNEUMONIA.  77 

It  is  to  be  observed  that  many  of  the  age  characteristics  discussed 
in  the  section  on  pulmonary  tuberculosis  are  to  be  noted  in  these 
data  for  pneumonia  (lobar  and  undefined).  For  both  these  diseases 
the  period  1  to  4  years  is  one  of  very  high  incidence.  The  rates 
decline  to  a  minimum  in  the  age  period  10  to  14  years  and  there- 
after increase  rapidly,  reaching  the  maximum  at  the  highest  age 
period  rather  than  at  the  period  of  middle  adult  life  as  in  tuber- 
culosis. Beginning  with  the  age  period  55  to  64  years  for  females 
and  65  to  74  years  for  males,  the  rates  for  pneumonia  (lobar  and 
undefined)  are  considerably  higher  than  those  for  pulmonary 
tuberculosis. 

The  trend  of  the  death  rate  for  pneumonia  in  recent  years 
has  been  somewhat  disquieting.  The  highest  death  rate  in  the 
Metropolitan  experience  was  found  in  1911  (89.2).  The  lowest 
was  for  the  year  1914  (68.9).  Since  1914  there  has  been  a  distinct 
increase  in  the  mortality  rate,  which  rose  to  74.4  in  1915  and  still 
higher,  to  80.8,  in  1916.  Much  the  same  picture  is  presented  by  the 
figures  for  the  Eegistration  Area.  The  year  of  maximum  mortal- 
ity in  the  population  figures,  89.2,  was  also  1911.  The  minimum 
was  reached  in  1914  and  the  same  general  tendency  toward  a  rise 
is  observable  in  later  years.  It  is  quite  possible  that  the  rates  in 
both  experiences  for  1911  are  higher  than  they  should  be  because 
our  inquiry  system  was  not  as  effective  in  the  early  years  of  this 
investigation  as  in  the  later  years  when  many  cases  of  so-called 
"  pneumonia  "  were  charged  to  bronchopneumonia  or  to  other  more 
definitely  described  diseases  as  a  result  of  the  supplementary  state- 
ments of  physicians. 

The  above  suggests  that  it  may  be  advisable  to  discuss  with  some 
fullness  the  routine  followed  in  this  office  in  assigning  deaths  re- 
ported as  due  to  "pneumonia."  In  every  instance  in  which  the 
case  was  returned  certified  as  due  to  "pneumonia,"  a  letter  was 
sent  to  the  physician  containing  one  of  the  following  inquiries: 

(a)  QUERY  FOR  DEATHS  OF  CHILDREN  UNDER  15  YEARS  OF  AGE  : 

Does  the  word  "pneumonia"  as  used  by  you  refer  to  lobar,  bronchial, 
grippal,  or  tuberculous  pneumonia?  Following  any  contagious  disease 
(measles,  whooping  cough,  scarlet  fever,  etc.)?  Traumatic?  If  so,  means 
and  nature  of  injury? 

(&)  OTHER  DEATHS: 

Does  the  word  "  pneumonia "  as  used  by  you  refer  to  lobar,  bronchial, 
grippal,  or  tuberculous  pneumonia?  Was  it  traumatic?  If  so,  was  death 


78  MORTALITY    STATISTICS   OP   INSURED   WAGE   EARNERS. 

due  to  suicide,  homicide  or  accident,  and  if  the  last,  what  kind  of  accident 
was  the  primary  cause  of  death  (steam  railroad,  street  car,  fall,  etc.)  f 

As  a  result  of  these  inquiries,  it  is  safe  to  say  that  thousands  of 
cases  have  been  definitely  established  as  due  either  to  the  lobar  or 
bronchial  form  of  the  disease.  Those  due  to  the  bronchial  form 
were  so  classified;  those  definitely  ascribed  as  due  to  the  "lobar" 
form  were  included  in  the  41,707  deaths  previously  referred  to  in 
this  section  of  the  report.  It  is  safe  to  say  that  not  less  than  ninety 
per  cent,  of  these  deaths  were  actually  caused  by  true  lobar  pneu- 
monia; the  remaining  cases  included  deaths  that  were  certified  as 
caused  by  pleuropneumonia,  double  pneumonia,  and  more  com- 
monly by  "pneumonia,"  where  no  additional  information  could  be 
obtained.  We  feel  confident  in  the  safety  of  this  estimate  because 
in  the  returns  of  the  Bureau  of  the  Census  the  proportion  of  lobar 
pneumonia  actually  recorded  under  this  title  was  87  per  cent.,  in 
recent  years.  The  inquiry  system  applied  to  the  returns  of  the 
present  study  has  covered  a  higher  proportion  of  such  reports 
during  the  period  than  that  carried  on  by  the  Census  Bureau  dur- 
ing the  same  period.  This  fact  would  undoubtedly  result  in  a 
larger  proportion  of  cases  properly  classified  as  true  lobar  pneu- 
monia. 

(b)  BRONCHOPNEUMONIA. 

Sixteen  thousand,  two  hundred  and  twenty-four  (16,224)  deaths 
from  bronchopneumonia  occurred  in  this  experience  during  the  six- 
year  period  1911  to  1916.  The  death  rate  was  30.2  per  100,000 
exposed. 

Color,  Sex  and  Age  Incidence. 

The  death  rate  of  the  colored  policy  holders,  both  male  and  fe- 
male, exceeded  that  of  the  white  group.  This  is  true  of  each  sex 
class  for  each  year  of  the  period  with  the  exception  of  the  year 
1912,  for  which  the  mortality  among  white  females  (27.7)  was  very 
slightly  higher  than  that  of  colored  females  (27.5).  There  is, 
according  to  the  Metropolitan  experience  for  the  sexennium  as  a 
whole,  very  little  difference  between  the  death  rates  of  the  two  sexes 
for  this  disease.  The  rate  at  all  ages  for  white  males  (29.6)  ex- 
ceeds only  very  slightly  that  for  white  females  (29.2),  while  that 
for  colored  males  at  all  ages  (37.7)  is  not  much  higher  than  for 
colored  females  (33.7).  Of  the  16,224  deaths  among  Metropolitan 
policyholders,  7,007,  or  43  per  cent.,  were  those  of  children  between 


PNEUMONIA.  79 

1  and  5  years  of  age.  If  this  proportion  is  less  than  that  in  the 
population  at  large,  it  is  because  the  first  year  of  life  is  excluded 
among  the  insured  and  this  is  an  age  of  heavy  incidence  for  bron- 
chopneumonia.  The  number  of  deaths  in  this  age  period  far  ex- 
ceeded that  of  any  other  age  group,  although  the  death  rate  (155.3) 
is  not  as  high  as  that  for  either  of  the  periods  65  to  74  years  or  75 
years  and  over  (185.3  and  426.9  respectively).  There  was,  of 
course,  a  far  greater  number  of  living  policyholders  during  the 
earlier  period. 

Further  analysis  of  the  mortality  for  bronchopneumonia  by  age 
groups  brings  out  a  number  of  rather  interesting  phenomena. 
Among  white  males  the  death  rate  for  the  period  1  to  4  years  was 
145.4;  the  corresponding  figure  for  white  females  was  139.9.  In 
this,  the  most  significant  age  group,  the  proportion  of  deaths  of 
males  to  those  of  females  was  somewhat  heavier  than  that  indicated 
by  the  death  rates  for  white  males  (29.6)  and  of  white  females 
(29.2)  at  all  ages.  In  the  next  age  period  5  to  9  years,  on  the 
other  hand,  a  higher  rate  among  white  persons  is  shown  for  fe- 
males (13.0)  than  for  males  (11.5).  Indeed,  for  each  of  the  next 
three  age  periods  the  rate  for  females  is  slightly  in  excess  of  that 
for  males.  When  the  age  group  25  to  34  years  is  reached  this  con- 
dition changes  and  more  or  less  pronounced  excesses  are  shown  for 
white  males  for  the  groups  25  to  34,  35  to  44,  45  to  54  and  55  to 
64  years.  In  the  two  highest  age  groups,  we  find  the  mortality 
among  white  females,  again,  to  be  higher  than  that  for  white  males. 
Since  the  number  of  deaths  that  occurred  and  the  number  of  per- 
sons exposed  is  large  enough  to  be  significant,  these  sex  character- 
istics of  bronchopneumonia  mortality  among  white  policyholders 
are  exceedingly  interesting. 

The  sex  distribution  of  the  mortality  among  colored  policyhold- 
ers is  less  significant  on  account  of  the  much  smaller  number  of 
deaths  involved  and  of  persons  exposed,  but  in  many  respects  it 
corresponds  with  that  of  the  white  policyholders.  The  death  rate 
among  colored  males  for  the  period  1  to  4  years  (329.4)  is  higher 
than  that  for  colored  females  (317.9) ;  for  the  next  two  age  periods 
the  higher  rates  are  shown  for  colored  girls.  For  the  age  period 
15  to  19  years  the  experience  was  contrary  to  that  among  white 
policyholders,  for  the  death  rate  for  males  (12.5)  exceeded  that  for 
females  (10.3).  From  this  age  period  to  the  higher  age  periods 


80 


MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


the  sex  ratio  of  bronchopneumonia  mortality  is  practically  the  same 
for  colored  persons  as  for  the  whites,,  except  that  in  the  highest 
age  group  the  excess  of  the  rate  for  females-  over  that  for  males  is 
much  smaller  among  colored  persons  than  for  the  corresponding 
age  period  among  white  persons.  The  number  of  deaths  involved 
in  this  last  age  group,  however,  is  small,  as  indeed,  are  the  num- 
bers in  several  of  the  age  periods. 

The  following  table  and  chart  show  the  death  rate  for  broncho- 
pneumonia  per  100,000  persons  exposed  by  certain  specified  age 
groups  for  all  policyholders  and  for  white  and  colored  policyhold- 
ers  by  sex,  for  the  period  1911  to  1916. 

TABLE  35. 

MORTALITY  PROM  BRONCHOPNEUMONIA,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

30.2 

29.6 

29.2 

37.7 

33.7 

1  to  4  

155.3 
13.4 
3.3 
3.7 
4.0 
6.4 
11.2 
23.3 
62.2 
185.3 
426.9 

145.4 
11.5 
2.7 
2.6 
2.8 
6.7 
14.0 
29.0 
65.0 
173.1 
350.4 

139.9 
13.0 
3.1 
2.9 
3.3 
4.6 
8.2 
18.2 
60.6 
202.7 
484.7 

329.4 
25.0 
6.0 
12.5 
10.2 
12.4 
18.4 
31.3 
69.0 
113.6 
343.0 

317.9 
26.2 
9.0 
10.3 
10.3 
9.4 
11.1 
26.2 
56.8 
153.9 
344.8 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

The  death  rate  for  this  disease  for  the  year  1911  was  26.1  and  a 
continuous  increase  is  shown  throughout  the  sexennium.  The 
maximum  mortality,  that  of  the  year  1916,  was  33.5  per  100,000. 
The  death  rates  for  the  several  years  of  the  period  are  much 
lower  than  those  for  the  corresponding  years  in  the  expanding 
Registration  Area,  but  the  increasing  mortality  is  in  evidence  for 
both  experiences;  it  was  not  continuous,  however,  in  the  Registra- 
tion Area.  In  the  latter  experience,  the  1914  rate  was  slightly 


PNEUMONIA. 


81 


82 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


lower  than  that  for  1913,  and  the  1916  rate  was  lower  than  that  for 
1915.  The  death  rate  for  bronchopneumonia  in  the  expanding 
Registration  Area  is  higher  than  that  for  the  group  of  insured 
wage  earners  because  bronchopneumonia  is  a  disease  which  takes 
its  largest  toll  among  infants  under  1  year  of  age.  The  expanding 
Registration  Area  experience  shows  that  about  40  per  cent,  of  the 
mortality  from  this  disease  is  that  of  infants  under  1  year  of  age. 
It  is  also  the  cause  of  death  of  many  thousands  of  people  of  70 
years  and  over.  Since  there  is  no  exposure  among  policyholders  for 
the  period  of  early  infancy  and  a  smaller  proportionate  exposure 
among  elderly  people  than  in  the  Registration  Area,  it  is  easy  to 
account  for  the  higher  bronchopneumonia  death  rate  of  the  latter 
group.  In  other  words,  the  experiences  are  not  comparable,  so  far 
as  the  crude  death  rates  are  concerned,  on  account  of  the  differing 
age  distributions  of  the  two  populations. 

The  following  table  gives  the  death  rates  for  bronchopneumonia 
for  all  policyholders,  and  for  white  and  colored  policyholders  by 
sex,  for  the  six-year  period  as  a  whole  and  for  each  year  compre- 
hended. The  upward  trend  of  the  mortality  charged  to  this  dis- 
ease is  obvious.  Chart  IX  graphically  illustrates  the  data  on  the 
trend  of  bronchopneumonia  mortality  in  this  experience. 

TABLE  36. 

MORTALITY  FROM  BRONCHOPNEUMONIA,  CLASSIFIED  BY  COLOB  AXD  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.  Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916. 

1916... 
1915... 
1914... 
1913... 
1912... 
1911... 

30.2 

29.6 

29.2 

37.7 

33.7 

33.5 
32.1 
31.4 
28.4 
28.1 
26.1 

32.7 
30.8 
31.1 
28.7 
27.7 
25.6 

32.6 
31.2 
29.7 
26.8 
27.7 
25.8 

43.3 
38.3 
39.9 
38.8 
34.4 
30.6 

37.5 
41.8 
37.8 
29.3 
27.5 
26.9 

Since  bronchopneumonia  is  a  disease  with  a  very  pronounced  age 
incidence,  interest  in  comparing  the  mortality  among  wage  earners 


PNEUMONIA. 


83 


Chart  IX. —  Mortality  rrom  Bronchopneumonia 

Death  Rate*  perlOO.OOOPersons   Exposed  By   Single  Years  1911   to  1916 

Experience  of  Metropolitan  Life  Insurance  Company,  Industrial  Department 


Co/oreaf Males 
Co/ored FemaJes 


84  MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

and  their  families  with  that  among  the  general  population  attaches 
chiefly  to  the  comparative  mortality  for  the  several  age  groups.  In 
order  to  compare  the  death  rate  of  young  children  it  is,  of  course, 
necessary  to  eliminate  the  exposure  under  1  year  of  age  in  the 
general  population,  since  there  is  no  corresponding  exposure  for 
the  policyholders.  For  the  age  group  1  to  4  years  the  estimated 
death  rate  for  bronchopneumonia  among  males  in  the  Registration 
Area  for  the  spTerminm  1910  to  1915  was  143.2  per  100.000  popu- 
lation. This  is  lower  than  the  corresponding  rate  for  white  males 
among  the  Industrial  policyholders  (145.4).  It  is  helieved,  how- 
ever, that  this  slight  difference  is  more  than  accounted  for  by  the 
higher  proportion  of  reports  of  cause  of  death  in  the  insurance 
experience  changed  from  "pneumonia"  to  bronchopneumonia  as 
the  result  of  information  additional  to  that  contained  in  the  origi- 
nal certification  and  obtained  through  correspondence  with  the 
physicians  who  made  the  reports.  Comparison  by  age  groups 
shows,  in  every  important  instance,  a  higher  mortality  for  the  white 
male  policyholders  than  for  males  in  the  general  population,  and 
this  excess  becomes  more  pronounced  in  the  higher  age  period?.  It 
is  probable  that  a  part  of  this  excess  in  the  rate  for  insured  wage 
earners  is  real  and  represents  the  effect  of  their  economic  and  sani- 
tary disadvantages. 

The  age  period  of  maximum  mortality  among  males  in  the  Reg- 
istration Area  is  shown  to  be  the  same  as  among  the  insured, 
namely,  the  highest  age  group,  75  years  and  over.  In  the  general 
population  experience,  however,  the  lowest  group,  one  to  four  years, 
shows  a  higher  death  rate  than  the  group  65  to  74  years.  This  is 
contrary  to  the  experience  for  the  Industrial  policyholders  in  that 
the  death  rate  for  white  males  for  the  age  period  65  to  74  years 
(173.1)  is  considerably  higher  than  that  covering  early  childhood 
(145.4). 

The  following  table  presents  a  comparison  of  the  death  rates  for 
bronchopneumonia  among  insured  lives  and  in  the  general  popula- 
tion of  the  expanding  Registration  Area. 

While  the  chief  interest  in  the  mortality  caused  by  bronchopneu- 
monia does  not  attach  to  the  main  wage  earning  periods,  there  are 
to  be  noted  a  few  rather  important  differences  in  the  ratios  of  the 
rates  for  males  and  of  females  which  are  in  evidence  in  comparing 
the  general  population  with  the  insurance  experience  on  white  lives. 
Beginning  at  the  period  15  to  19  years,  the  death  rate  among  the 


PNEUMONIA. 


85 


TABLE  37. 

MORTALITY  FROM  BBONCHOPNEUMONIA. 

Death  Rates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Eegistra- 
tion  Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

U.  S.  Reg. 

Percentage 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Percentage 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

29.6 

26.9 

110.0 

29.2 

30.0 

97.3 

1  to  4... 

145.4 

143.2 

101.5 

139.9 

134.5 

104.0 

5  to  9... 

11.5 

10.9 

105.5 

13.0 

11.2 

116.1 

10  to  14.. 

2.7 

2.7 

100.0 

3.1 

3.7 

83.8 

15  to  19.. 

2.6 

2.9 

89.7 

2.9 

2.9 

100.0 

20  to  24.. 

2.8 

3.3 

84.8 

3.3 

3.6 

91.7 

25  to  34.. 

6.7 

4.7 

142.6 

4.6 

4.2 

109.5 

35  to  44.. 

14.0 

8.7 

160.9 

8.2 

6.5 

126.2 

45  to  54.. 

29.0 

16.0 

181.3 

18.2 

13.3 

136.8 

55  to  64.. 

65.0 

35.9 

181.1 

60.6 

39.5 

153.4 

65  to  74.. 

173.1 

94.1 

184.0 

202.7 

124.2 

163.2 

75  and  over 

350.4 

304.3 

115.1 

484.7 

430.0 

112.7 

general  population  is  identical  for  males  and  females,  namely,  2.9 
per  100,000  population.  In  the  insurance  experience  that  for 
females  (also  2.9)  exceeds  slightly  that  for  males  (2.6).  In  the 
next  age  period  (20  to  24  years),  there  is  a  slight  excess  in  each 
experience  in  the  rate  for  females,  but  in  the  period  25  to  34  years, 
the  white  male  insurance  experience  with  a  rate  of  6.7  per  100,000 
exposed  shows  a  much  greater  excess  over  the  rate  for  insured  white 
females  (4.6)  than  is  in  evidence  for  the  general  population,  for 
which  the  corresponding  death  rates  were  for  males  (4.7)  and  for 
females  (4.2).  The  next  age  group  shows  higher  rates  for  the 
males  in  each  experience,  but  the  difference  between  the  rates  by 
sex  is  much  greater  among  the  insured  (14.0  for  white  males  as 
compared  with  8.2  for  white  females)  than  among  the  general 
population  (8.7  for  males  and  6.5  for  females).  For  the  period 
45  to  54  years  with  higher  death  rates  (insured  white  males  29.0, 
white  females  18.2;  general  population:  males  16.0.  females  13.3) 
there  is,  again,  a  greater  divergence  between  mortality  of  males  and 
females  among  the  wage  earning  group  than  prevails  for  the  popu- 
lation as  a  whole.  When  the  age  group  55  to  64  years  is  reached, 


86  MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

we  find  that  the  death  rate  for  females  in  the  general  population 
exceeds  that  for  the  males  (males  35.9,  females  39.5),  which  is  con- 
trary to  the  facts  shown  for  the  insured  group  (white  males  65.0, 
white  females  60.6;  colored  males,  69.0,  colored  females,  56.8). 

Reliability  of  the  Figures  for  Bronchopneumonia  Mortality. 

Death  rates  for  bronchopneumonia  should  be  used  with  caution. 
It  will  be  noted  that  the  figures  indicating  the  mortality  among 
insured  wage  earners  from  this  disease  show  a  continuous  increase 
during  the  six  years  covered  by  this  report.  The  rates  for  the 
expanding  Registration  Area  also  show  an  increase  which  was  con- 
tinuous during  the  same  period  with  the  exception  of  two  years, 
for  each  of  which  the  deviation  was  too  small  to  be  significant. 
Prior  to  1911  the  published  rates  for  the  Registration  Area  were 
still  lower  than  those  for  the  period  1911  to  1916,  and  a  superficial 
analysis  of  Registration  Area  experience  would  lead  one  to  believe 
that  in  the  seventeen  years  covered  thereby  there  had  been  an 
increase  in  the  mortality  caused  by  this  disease  of  124  per  cent. 
Briefly,  it  may  be  said  that  the  increased  published  death  rates  for 
bronchopneumonia  in  both  the  insurance  and  general  population 
experience  have  been  brought  about,  first,  by  improved  statements 
of  cause  of  death  on  certificates  and  insurance  forms,  and  second,  by 
the  ever-increasing  strictness  with  which  reports  of  "  pneumonia," 
unqualified,  are  sent  back  to  certifying  physicians  with  requests  for 
information  as  to  the  type  of  the  disease.  Still  another  matter 
should  be  considered  in  analyzing  the  published  mortality  from 
bronchopneumonia  in  this  or  any  other  volume.  To  a  certain  ex- 
tent the  statement  of  "bronchopneumonia"  itself  is  an  unsatis- 
factory report  of  cause  of  death.  While  it  is  probably  true  that 
the  disease  is  idiopathic  in  the  majority  of  cases  where  it  is  the 
only  cause  reported,  it  is  also  true,  and  has  been  demonstrated,  that 
in  many  cases  the  condition  is  a  sequela  of  other  diseases  not  men- 
tioned on  the  physician's  original  report. 


CHAPTEE  VII. 
BRIGHT'S  DISEASE. 

Certification  of  Bright' s  Disease. 

The  statistical  treatment  of  Bright's  disease  mortality  presents  a 
number  of  difficulties.  The  condition,  as  will  be  described  more 
fully  later,  often  occurs  in  conjunction  with  the  so-called  cardio- 
vascular diseases,  such  as  organic  diseases  of  the  heart,  arterio- 
sclerosis, cerebral  hemorrhage,  etc.  In  such  instances,  much  depends, 
in  the  statistical  registration  of  the  death,  upon  the  definiteness  with 
which  the  cause  of  death  has  been  certified  by  the  physician. 
Where,  for  example,  the  statement  is  "  Bright's  disease  "  combined 
with  valvular  disease  of  the  heart,  the  death  is  assigned  to  the  latter 
condition.  A  more  specific  statement  of  Bright's  disease  as  chronic 
interstitial  nephritis  and  valvular  disease  of  the  heart  is,  on  the 
other  hand,  registered  as  a  death  from  Bright's  disease.  The  sev- 
eral terms  used  by  physicians  may  refer  to  precisely  the  same  dis- 
eases and  conditions  in  each  of  the  cases,  but,  in  the  one  instance, 
the  assignment  of  the  death  is  to  a  heart  condition,  and  in  the 
other  to  the  condition  of  the  kidney.  Standard  practice  requires  such 
assignment;  nevertheless,  it  is  generally  believed  that,  as  a  result 
of  the  present  status  of  reporting,  many  cases  of  true  Bright's  dis- 
ease which  would  receive  precedence  if  fully  described,  are  lost 
from  the  record  in  view  of  the  fact  that  few  tables  contain  any  ref- 
erence to  the  secondary  causes  of  death. 

Mortality  from  Bright* s  Disease  among  Insured  Wage  Earners. 

Even  under  the  above  considerations,  Bright's  disease  appears  as 
the  fourth  cause  in  numerical  importance  in  the  Industrial  expe- 
rience of  the  Metropolitan  Life  Insurance  Company.  In  all,  52,067 
deaths  were  registered  in  the  six-year  period,  corresponding  to  a 
rate  of  96.8  per  100,000  living.*  In  general,  the  contour  of  the 

*  These  deaths  include  those  certified  as  due  to  ' '  Bright 's  disease, ' '  or 
"nephritis,"  without  further  qualification;  also  those  reported  as  due  to 
chronic  Bright's  disease,  chronic  nephritis,  and  to  the  several  types  of 

87 


88 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


curve  of  mortality  according  to  age  is  very  similar  to  that  for  or- 
ganic heart  disease,  although  the  figures  are  in  every  case  lower 
than  those  for  the  other  condition.  The  mortality  is  comparatively 
low  until  the  age  period  20  to  24  years  is  reached.  From  this  point 
onward,  the  increases  are  very  marked,  the  rates  (with  one  excep- 
tion) more  than  doubling  from  age  period  to  age  period  until  the 
maximum  is  reached  in  the  most  advanced  age  group,  75  years  and 
over. 

The  following  table  and  graph  present  the  detailed  relations  of 
the  death  rate  from  Bright's  disease  by  color,  sex  and  age  classes: 

TABLE  38. 
MORTALITY  FROM  BRIGHT'S  DISEASE,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE 

PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

96.8 

97.1 

88.1 

138.7 

121.3 

1  to  4  

5.7 
4.3 
4.9 
8.6 
15.3 
36.3 
101.3 
216.7 
453.3 
970.6 
1715.2 

5.8 
4.2 
3.8 
7.8 
14.8 
38.5 
119.3 
259.8 
539.3 
1146.3 
2106.7 

4.4 
4.2 
5.6 
8.8 
14.2 
31.8 
80.0 
171.5 
364.7 
826.0 
1466.6 

18.6 
4.9 
7.6 
9.9 
20.7 
41.5 
130.6 
301.9 
709.5 
1501.8 
2140.2 

9.5 
6.1 
5.9 
12.9 
22.2 
46.9 
127.8 
264.8 
501.3 
873.8 
1624.2 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

Bright's  disease  is  more  commonly  represented  in  the  mortality 
experience  of  colored  persons  than  among  white  persons.  This  is 
true  for  each  of  the  sexes  and  for  every  age  period.  At  some  of  the 
age  periods,  the  excess  among  colored  persons  is  very  marked  in- 
deed, although  there  is  some  irregularity  as  to  the  amount. 

There  is  also  a  sex  distinction  in  Brighfs  disease  mortality  which 
merits  some  attention.  Males  show  higher  rates  in  all  of  the  more 

Bright's  Disea?e,  for  example,  chronic  interstitial  nephritis,  chronic  paren- 
chymatous  nephritis,  chronic  diffuse  nephritis,  etc.  Deaths  from  acute 
nephritis  are  not  included. 


BRIGHT  S  DISEASE. 


89 


jfi    i   i   i   i    i    t   i    t   i 


90  MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

significant  age  periods.  In  those  few  age  periods  where  females 
show  higher  rates,  the  incidence  of  the  disease  is  not  high  and  the 
facts  are  somewhat  clouded  by  the  possibility  of  incorrect  certifica- 
tion. Thus,  in  the  age  period  15  to  19  years,  where  the  death  rate 
for  females  for  both  white  and  colored  lives  is  significantly  higher, 
it  is  quite  possible  that  this  results  from  the  inclusion  of  deaths 
from  puerperal  nephritis,  which,  if  more  complete  statements  had 
been  made  would  not  have  been  assigned  to  Bright's  disease,  but  to 
the  puerperal  cause. 

Beginning  with  ages  ten  and  over,  the  rate  increases  regularly 
with  advancing  age.  The  peculiar  situation  under  ten,  and  espe- 
cially between  one  and  four  years,  is  probably  explained  by  the 
inclusion  of  deaths  from  acute  nephritis  improperly  certified  as 
"  Bright's  disease  "  or  "  nephritis."  Many  of  these  deaths  should, 
properly,  have  been  classified  under  one  of  the  communicable  dis- 
eases of  childhood,  which,  in  so  many  instances,  are  the  primary 
factors  in  such  deaths. 

Mortality  from  Bright's  Disease  among  White  Insured  Wage  Earn- 
ers and  among  the  General  Population  of  the  Expanding 
Registration  Area  Compared. 

As  was  the  case  in  the  discussion  of  organic  heart  disease,  we 
find  here  a  higher  incidence  of  Bright's  disease  among  insured 
white  lives  than  in  the  general  population.  This  is  true  for  each 
period  beyond  age  20  years  for  both  males  and  females.  The  com- 
parison is  limited  to  the  ages  beyond  20  years  because  it  is  desired 
to  eliminate  the  questionable  data  of  the  ages  under  20  when,  also, 
the  rates  are  comparatively  low.  The  excess  is  pronounced  among 
males  but  by  no  means  so  marked  among  females.  The  maximum 
ratio  of  excess  among  white  males  occurs  in  the  period  35  to  44 
years  when  the  rate  is  88.2  per  cent,  higher  among  the  insured  than 
in  the  general  population.  This  ratio  of  excess  decreases  there- 
after, with  a  single  exception.  If  it  were  possible  to  eliminate  the 
small  percentage  of  colored  persons  from  the  population  of  the 
Registration  Area,  the  excess  of  the  insurance  experience  would  be 
even  larger.  Among  females,  the  maximum  difference  in  favor  of 
the  population  occurs  in  the  period  65  to  74  years  (44.9  per  cent.). 
These  facts  in  the  statistics  for  insured  wage  earners  suggest  that 
the  more  arduous  pursuits  of  the  industrial  population  may  well  be 


HEIGHT'S  DISEASE. 


91 


contributing  factors  in  causing,  or  at  least  exciting,  abnormal  con- 
ditions of  the  kidney.  Other  factors,  also,  undoubtedly  play  their 
part;  possibly  the  more  general  use  of  alcohol  is  important  here, 
especially  at  the  ages  of  middle  adult  life. 

The  following  table  presents  the  death  rates  for  the  insured  and 
the  population  of  the  expanding  Eegistration  Area,  side  by  side, 
by  sex  and  from  ages  20  upward : 

TABLE  39. 

MORTALITY  FROM  BRIGHT 's  DISEASE. 

Death  Bates  per  100,000  Persons  Exposed.     Classified  ~by  Sex  and  "by  Age 

Periods,  20  Tears  and  Over.     Insured  White  Lives  in  Experience  of 

Metropolitan  Life  Insurance  Company,  Industrial  Department  (1911 

to  1916)    and  General  Population  Experience   of  Expanding 

Eegistration  Area  of  the  United  States   (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

(White). 

U.  S.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 

(White). 

U.  S.  Reg. 

Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

All  age&—  20 
and  over 

198.1 

156.8 

126.3 

149.7 

131.4 

113.9 

20  to  24.  ... 
25  to  34.... 
35  to  44.... 
45  to  54.... 
55  to  64.... 
65  to  74.  ... 
75  and  over. 

14.8 
38.5 
119.3 
259.8 
539.3 
1146.3 
2106.7 

11.0 
24.1 
63.4 
157.3 
368.4 
773.1 
1587.9 

134.5 
159.8 
188.2 
165.2 
146.4 
148.3 
132.7 

14.2 
31.8 
80.0 
171.5 
364.7 
826.0 
1466.6 

13.4 
27.0 
62.3 
131.7 
275.2 
569.9 
1129.5 

106.0 
117.8 
128.4 
130.2 
132.5 
144.9 
129.8 

Trend  of  the  Death  Rate  from  Bright' s  Disease. 

On  the  face  of  the  figures  there  is  a  slight  upward  trend  in  the 
death  rate  from  Bright's  disease  in  this  experience.  The  tendency 
is  not  alarming,  in  any  sense,  in  view  of  the  possibility  that  in  more 
recent  years  physicians  have  been  more  definite  in  their  state- 
ments of  cause  of  death  than  at  the  beginning  of  the  six-year  period. 
The  office  practice  of  the  Statistical  Bureau  has  also  affected  the 
figures,  since  a  larger  number  of  inquiries  to  physicians  has  been 
made  in  more  recent  years  than  at  the  beginning  of  the  study,  more 
particularly  with  reference  to  undesirable  statements  of  "acute 
nephritis."  There  should,  therefore,  be  no  unrestrained  interpre- 
tation of  the  figures  shown  below,  especially  in  view  of  the  diffi- 
culties pointed  out  at  the  beginning  of  this  section  on  the  still 


92 


MORTALITY    STATISTICS   OF   INSURED    WAGE   EARNERS. 


unsettled  condition  of  the  cause  of  death  classification  procedure 
in  cases  where  Bright's  disease  is  associated  with  cardiovascular 
diseases.  The  figures  are  presented  by  color  and  sex  for  the  indi- 
vidual years  between  1911  and  1916 : 

TABLE  40. 
MORTALITY  FROM  BRIGHT 's  DISEASE,  CLASSIFIED  BY  COLOR  AND  BY  Sax. 

Death  Bates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916 

1916.  . 

1915.. 
1914.. 
1913.. 
1912.. 
1911.. 

96.8 

97.1 

88.1 

138.7 

121.3 

99.0 
95.7 
95.4 
96.0 
99.4 
95.0 

99.0 
91.6 
94.7 
99.0 
101.5 
97.3 

90.3 

88.4 
86.7 
85.2 
90.4 
87.4 

138.9 
154.1 
142.7 
138.6 
132.9 
122.9 

130.8 

126.2 
121.7 
117.5 
120.7 
108.5 

The  problem  of  increase  in  Bright's  disease  mortality,  if  there 
is  one,  is  much  more  acute  among  colored  lives  than  among  white 
lives  and  if  any  significance  attaches  to  the  increasing  mortality  in 
more  recent  years,  it  applies  entirely  to  the  colored  race.  It  is  not 
possible  at  this  time  to  explain  satisfactorily  what  forces  are  at 
work  behind  the  rapidly  changing  figures  for  the  colored  group. 


CHAPTER  VIII. 

EXTERNAL  CAUSES  OF  DEATH  (ACCIDENT,  SUICIDE  AND  HOMICIDE). 

The  group  of  the  external  causes  of  death  is  the  fifth  in  order  of 
numerical  importance  in  this  investigation. 

In  any  discussion  of  mortality,  we  may,  in  general,  distinguish 
two  main  classes;  first,  those  diseases  and  conditions  which  arise 
from  pathologic  processes  within  the  body,  and  second,  conditions 
which  follow  injury  by  some  means  or  agency  external  to  the  hu- 
man economy.  Under  each  of  these  two  fundamental  divisions,  we 
attempt  to  identify  the  specific  agencies  at  work.  Oftentimes,  we 
must  have  recourse  simply  to  a  statement  of  the  disease  or  condition 
present,  without  reference  to  the  particular  causative  agency  pro- 
ducing the  disease.  This  observation  applies  especially  to  diseases 
of  internal  origin.  The  "external"  conditions  are  by  comparison 
less  difficult  to  determine  causally.  Our  first  approach  to  them  is 
to  establish  three  classes,  the  division  being  made  with  respect  to 
the  element  of  human  volition  involved  in  the  fact  of  injury.  The 
first  group  consists  of  the  accidental  deaths,  those  accomplished  by 
pure  chance  or  through  personal  negligence  without  deliberate  in- 
tent to  kill,  maim  or  incapacitate.  The  second  group  of  external 
causes  of  death  consists  of  the  suicides,  or  cases  where  there  was 
deliberate  intent  to  accomplish  self-destruction  Under  the  third 
class,  we  consider  all  deaths  (except  war  deaths)  which  arise  from 
the  impulse  of  one  person  to  kill  or  injure  another.  These  latter 
are  "homicides."  For  each  of  these  main  classes  of  violence,  we 
shall  endeavor  further  to  distinguish  the  means  or  agency  of  in- 
jury. War  deaths  have  been  taken  from  the  class  of  accidental  and 
unspecified  violence  and  shown  separately  for  purposes  of  this 
report. 

During  the  six-year  period  covered  by  this  investigation  of  wage 
earners'  mortality,  there  were  50,712  deaths  from  external  violence 
of  all  kinds.  The  following  table  gives  the  incidence  of  the  three 
chief  groups  of  external  causes  represented  in  our  records : 

93 


MORTALITY    STATISTICS   OF   INSURED    WAGE   EARNERS. 


TABLE  41. 

MORTALITY  PROM  EXTERNAL  CAUSES  or  DEATH.    CLASSIFIED  ACCORDING  TO 

MAIN  GROUPS. 

Deaths  and  Death  Bates  per  100,000  Persons  Exposed  and  Per  Cent,  of 
Total  Mortality  from  External  Causes  Represented  in  Each  Main 

Group.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


ruts  of  External  Violence. 

Number  of 
Deaths. 

Per  Cent,  of 
Total  External 
Causes. 

Death  Rate 
per  100.000 
Exposed. 

Total  external  causes  

50,712 

100.0 

94.3 

Accidents,  incl.  unspec.  violence  * 
Suicides  

39,268 
6,542 

77.4 
12.9 

73.0 
12.2 

Homicides  

3,753 

7.4 

7.0 

War  deaths  

1,149 

2.3 

2.1 

*  Excludes  ' '  war  deaths. ' ' 

The  total  death  rate  corresponding  to  the  50,712  deaths  was  94.3 
per  100,000,  which,  as  we  shall  see  later,  is  very  considerably  in 
excess  of  the  rate  for  the  external  causes  prevailing  in  the  general 
population  of  the  expanding  Registration  Area.  More  than  three 
quarters  of  these  deaths  were  due  to  accidents.  If  "war  deaths" 
were  included,  as  perhaps  they  should  be  to  follow  classification 
practice,  the  proportion  would  reach  nearly  80  per  cent.  Suicides 
comprise  12.9  per  cent,  and  homicides  7.4  per  cent,  additional. 
We  shall  consider  in  detail  first  the  group  of  accidents. 

ACCIDENTS,  INCLUDING  UNSPECIFIED  VIOLENCE. 

The  general  accident  problem  in  the  United  States,  and  espe- 
cially as  it  affects  the  wage  earner,  should  interest  us  because  of 
the  very  considerable  mortality  which  results  from  this  group  of 
causes.  It  would  appear  that  the  special  conditions  of  American 
life  and  industry  still  give  rise  to  hazards  which  result  in  an  extra- 
ordinarily large  fatal  accident  rate.  When  compared  with  acci- 
dent mortality  in  England  and  Wales,  the  American  figures  show 
up  especially  badly.  In  the  year  before  the  war,  1913,  the  fatal 
accident  rate  of  England  and  Wales  was,  for  males  35  to  44  years. 
62.4  per  100,000.  In  the  Registration  Area  of  the  United  States, 
the  rate  for  males  at  these  ages  was  139.6  per  100,000,  and,  among 


EXTERNAL  CAUSES  OF  DEATH.  95 

the  insured  white  males,  the  rate  was  154.3.  In  other  words,  the 
rate  for  England  and  Wales  was  44.7  per  cent,  of  that  for  the  ex- 
panding Registration  Area  of  the  United  States  and  only  40.4  per 
cent,  of  the  rate  for  insured  white  males.  Even  when  we  consider 
the  chief  types  of  fatal  accidents,  such  as  falls,  burns,  drowning, 
and  steam  railroad  accidents  in  these  three  series  of  figures,  the 
rates  of  mortality  as  recorded  for  the  United  States  are  much  above 
the  figures  for  England  and  Wales,  and  those  for  the  Industrial 
policyholders  are,  for  the  significant  age  periods,  highest  of  all. 
The  data  on  fatal  accidents  and  especially  the  specific  forms  of  ac- 
cidental injury  which  we  have  included  for  American  wage  earners 
should,  therefore,  constitute  a  very  valuable  contribution  for  the 
further  study  of  the  accident  problem  and  should  prove  especially 
useful  in  the  movement  for  increased  industrial  and  public  safety 
which  has  been  developed  during  the  last  ten  years. 

The  39,268  fatal  accidents  of  all  kinds,  as  we  have  seen,  corre- 
sponded to  a  rate  of  73.0  per  100,000  persons  exposed.  The  fatal 
accident  rate  for  males  of  both  white  and  colored  groups  was  more 
than  three  times  the  rate  for  females.  The  recorded  fatal  accident 
rate  for  colored  males  was  somewhat  higher  than  the  rate  for  white 
males ;  all  ages  one  and  over  being  combined  for  purposes  of  these 
comparisons. 

The  accident  death  rate  varies  considerably  with  age;  in  fact, 
we  may  distinguish  three  divisional  periods  of  age  incidence.  These 
are  the  period  of  early  childhood,  the  period  of  occupational  stress 
and  finally  the  period  of  old  age.  Considering  the  group  as  a 
whole,  we  find  that  the  highest  accident  death  rate  under  age  45 
was  recorded  between  the  ages  1  and  under  5  years.  There  is  a 
decline  in  the  rate  from  the  figure  under  5  years  of  age  (93.7  per 
100,000)  to  the  rate  at  the  age  group  10  to  14  years  (41.4  per 
100,000).  This  latter  rate  is  the  minimum  for  any  age  period. 
Beginning  with  the  age  group  15  to  19  years  there  is  a  gradually 
rising  rate  up  to  the  highest  significant  age  period.  For  the  white 
male  and  white  female  groups  the  minimum  accident  death  rate  is 
recorded,  as  for  the  total  experience,  between  10  and  14  years ;  but 
for  colored  males  the  minimum  rate  is  reached  between  5  and  9 
years  and  for  colored  females  between  15  and  19  years.  Only  the 
white  males  exhibit  a  progressively  increasing  accident  death  rate 
with  advancing  age,  beginning  with  the  period  15  to  19  years. 
White  females  show  a  rather  stationary  tendency  in  the  mortality 


96 


MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


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EXTERNAL  CAUSES  OF  DEATH. 


97 


rate  between  15  and  35  years  of  age.  Between  15  and  24  years 
colored  males  show  a  tendency  toward  decline;  thereafter  they  ex- 
hibit a  rising  death  rate.  Colored  females  show  a  fluctuating  fatal 
accident  rate  between  10  and  44  years  and  a  rising  rate  thereafter. 
These  facts  are  shown  in  the  following  table,  and  in  Chart  XI  on 
page  96: 

TABLE  42. 
MORTALITY  FROM  ACCIDENTAL  AND  UNSPECIFIED  VIOLENCE,*  CLASSIFIED  BY 

COLOR,  SEX  AND  BY  AGE  PEBIOD. 

Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Male. 

Female. 

Male. 

Female. 

All  ages  —  one  and 
over  

73.0 

115.9 

36.4 

121.4 

38.8 

1  to  4  

93.7 
51.4 
41.4 
53.4 
55.6 
57.9 
71.6 
95.2 
137.2 
251.4 
477.8 

100.9 
68.9 
65.1 
85.7 
99.8 
114.5 
154.3 
195.1 
246.5 
346.0 
482.4 

79.4 
31.9 
14.4 
16.9 
16.5 
15.7 
19.4 
35.5 
73.2 
201.1 
496.4 

151.3 
67.9 
83.5 
131.7 
109.4 
115.3 
124.8 
145.6 
180.7 
247.2 
315.5 

126.3 
51.2 
22.7 
18.2 
25.6 
22.5 
27.1 
41.1 
59.0 
167.9 
353.9 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  . 

55  to  64  

65  to  74  ..    . 

75  and  over  . 

*  War  deaths  excluded. 

Color  Ratio  of  Accident  Mortality. 

The  fatal  accident  rates  of  the  white  and  colored  races  are,  as 
we  have  seen,  very  different.  We  find,  for  example,  that  under 
5  years  of  age,  colored  children,  both  males  and  females,  show  a 
fatal  accident  rate  about  1£  times  that  of  white  children.  In  the 
period  5  to  9  years  colored  males  show  a  fatal  accident  rate  just  a 
little  less  than  the  white  male  rate.  Between  15  and  19  years,  how- 
ever, we  observe  the  maximum  percentage  of  excess  of  colored  male 
over  white  male  accident  mortality.  Colored  females,  on  the  other 
hand,  show  their  maximum  percentage  of  excess  in  accident  mor- 
tality between  5  and  9  years  of  age.  After  the  age  period  25  to  34 
years,  colored  males  show  a  lower  mortality  than  white  males,  which 
condition  is  probably  the  result  of  their  safer  occupational  condi- 
8 


08 


MORTALITY    STATISTICS   OF    INSURED   WAGE   EARNERS. 


tions.  A  similar  condition  of  lower  mortality  prevails  among  the 
colored  females  after  45  to  54  years,  but  the  cause  for  this  is  diffi- 
cult to  ascertain.  The  following  table  affords  a  comparison  of 
white  and  colored  accident  mortality  according  to  sex : 

TABLE  43. 

MORTALITY  FEOM  ACCIDENTAL  AND  UNSPECIFIED  VIOLENCE/ 
Percentage,  Colored  of  White  Mortality  at  Specified  Age  Periods  for  Each 

Sex.     1911  to  1916. 

Metropolitan  Life   Insurance   Company,   Mortality   Experience.     Industrial 

Department. 


Ace  Period. 

Percentage,  Colored  of  White  Mortality. 

Males. 

Females. 

All  ages  —  one  and  over  .  . 
1  to  4     

104.7 

106.6 

150.0 

98.5 
128.3 
153.7 
109.6 
100.7 
80.9 
74.6 
73.3 
71.4 
65.4 

159.1 
160.5 
157.6 
107.7 
155.2 
143.3 
139.7 
115.8 
80.6 
83.5 
71.3 

5  to9     

10  to  14     

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

*  War  deaths  excluded. 

Sex  Ratio  of  Accident  Mortality. 

The  differences  in  the  stresses  of  occupation  between  the  sexes 
are  clearly  reflected  in  the  accident  death  rates.  Considering  white 
lives  first,  there  was  an  excess  of  the  male  accident  rate  over  the 
female  rate  in  every  age  period  of  our  data,  with  the  exception  of 
the  last  age  group,  75  years  and  over.  The  maximum  percentage  of 
excess  of  male  accident  mortality  is  found  between  35  and  44  years 
of  age,  when  the  male  rate  is  nearly  eight  times  greater.  Among 
white  lives  between  1  and  45  years  of  age  there  is  increasing  per- 
centage of  excess  of  male  over  female  accident  mortality ;  after  45, 
the  excess  becomes  regularly  less.  Colored  persons  did  not  show 
any  such  increase  with  age  in  the  excess  percentage  of  male  over 
female  mortality.  The  maximum  percentage  of  excess  of  males 
over  females  among  colored  persons  is  found  between  the  ages  15 
and  19  years,  where  colored  males  show  a  fatal  accident  rate  nearly 


EXTERNAL  CAUSES  OF  DEATH. 


99 


7£  times  that  of  colored  females.     These  facts  are  exhibited  in  the 
following  table : 

TABLE  44. 

MORTALITY  FEOM  ACCIDENTAL  AND  UNSPECIFIED  VIOLENCE.* 
Percentage,  Male  of  Female  Mortality  at  Specified  Age  Periods  for  Each 

Color   Class,     1911   to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period 

Percentage.  Male  of  Female  Mortality. 

White. 

Colored. 

All  ages  —  one  and  over  .  . 
1  to  4.. 

318.4 

312.9 

127.1 
216.0 
452.1 
507.1 
604.8 
729.3 
795.4 
549.6 
336.7 
172.1 
97.2 

119.8 
132.6 
367.8 
723.6 
427.3 
512.4 
460.5 
354.3 
306.3 
147.2 
89.1 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64     

65  to  74  

75  and  over  

*  War  deaths  excluded. 

Fatal  Accident  Rate  among  Insured  Wage  Earners  and  Population 
of  the  Expanding  Registration  Area  Compared. 

Before  proceeding  to  a  detailed  consideration  of  the  various 
forms  of  accidents  represented  in  our  experience,  it  might  be  well, 
in  passing,  to  exhibit  a  table  of  the  accident  death  rates  per  100,000 
among  white  insured  wage  earners  and  in  the  general  population 
of  the  expanding  Eegistration  Area  of  the  United  States.  The 
table  on  page  100  affords  a  view  of  these  data. 

Under  20  years  and  after  35  years  of  age  white  males  of  the  in- 
sured wage  earners'  group  show  a  higher  accident  mortality  than 
do  males  in  the  Registration  Area  in  general.  For  the  ages  under 
5  years,  insured  white  males  show  an  accident  death  rate  5  per  cent, 
in  excess,  between  5  and  9  years,  17  per  cent.,  and  between  10  and 
14,  14  per  cent,  in  excess  of  the  rates  among  males  in  the  corre- 
sponding age  groups  of  the  general  population.  Between  20  and 
34  years  of  age  insured  white  male  wage  earners  show  a  lower  mor- 
tality from  accidents  than  was  recorded  among  males  in  the  Regis- 
tration Area  record.  Beginning  with  the  age  period  35  to  44 


100 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


TABLE  45. 

MORTALITY  FROM  ACCIDENTAL  AND  UNSPECIFIED  VIOLENCE.* 
Death  Rates  per  100,000  Person*  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1916). 


Male*. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

U.  8.  Ken. 

Percentage 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

0.  8.  Ref. 

Percentage 
M.  L.  I.  Co. 

(White). 

Are*. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

115.9 

120.8 

95.9 

36.4 

37.4 

97.3 

1  to4... 

100.9 

96.4 

104.7 

79.4 

76.5 

103.8 

5  to  9... 

68.9 

58.8 

117.2 

31.9 

29.6 

107.8 

10  to  14.. 

65.1 

56.9 

114.4 

14.4 

13.0 

110.8 

15  to  19.. 

85.7 

85.0 

100.8 

16.9 

15.4 

109.7 

20  to  24.. 

99.8 

116.6 

85.6 

16.5 

17.0 

97.1 

25  to  34.. 

114.5 

123.4 

92.8 

15.7 

15.5 

101.3 

35  to  44.. 

154.3 

139.6 

110.5 

19.4 

18.9 

102.6 

45  to  54.. 

195.1 

156.8 

124.4 

35.5 

27.7 

128.2 

55  to  64.. 

246.5 

178.5 

138.1 

73.2 

49.0 

149.4 

65  to  74.. 

346.0 

214.3 

161.5 

201.1 

118.1 

170.3 

75  and  over 

482.4 

41S.O 

115.4 

496.4 

534.8 

92.8 

*  War  deaths  excluded. 

years,  however,  accident  mortality  among  white  male  insured  wage 
earners  begins  progressively  to  exceed  the  rates  among  males  in  the 
general  population  up  to  and  including  the  period  65  to  74  years. 
The  figures  for  ages  beyond  75  years  are  not  significant  in  view 
of  the  small  exposure. 

The  comparisons  between  insured  white  females  and  females  in 
the  general  population  also  show  higher  death  rates  for  the  insured 
group,  with  the  exception  of  the  age  period  20  to  24  years,  than  for 
the  group  of  females  in  the  general  population.  The  differences 
are  not  so  marked,  however,  as  they  were  for  the  males.  Below  20 
years  of  age  the  percentages  of  excess  of  accident  mortality  among 
insured  white  females  are  variable.  Beginning  with  the  age  period 
25  to  34  years  there  is  a  progressive  increase  in  the  excess  of  acci- 
dent fatality  rates  among  white  female  wage  earners  over  the  rates 
for  females  in  the  general  population. 

Fatal  Accidents  According  to  Specific  Means  or  Nature  of  Injury. 

The  foregoing  observations  on  accident  mortality  were  made 

without  reference  to  the  specific  nature  or  means  of  injury.     We 


EXTERNAL  CAUSES  OF  DEATH. 


101 


shall  now  consider  briefly  the  several  inclusions  under  the  general 
title  as  shown  in  the  following  table : 

TABLE  46. 

MORTALITY  FROM  ACCIDENTAL  AND  UNSPECIFIED  VIOLENCE.* 
Deaths  and  Death  Bates  per  100,000  Persons  Exposed  by  Specified  Causes 

and  by  Color  and  Sex.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 
Department. 


Cause  of  Death. 

Persons. 

Rate  per  100.000. 

Deaths. 

Rate 
per 
100.000. 

White. 

Colored. 

Males. 

Fe- 
males. 

Males. 

Fe- 
males. 

ACCIDENTS  AND  UNSPECIFIED 
VIOLENCE  —  TOTAL*  

39268 

73.0 

115.9 

36.4 

121.4 

38.8 

Poisoning  by  food     

622 
1144 
576 
4714 

1431 

5757 
1029 

93 

6917 

660 
612 
48 
905 

4485 
1600 
2507 
1658 
381 
233 
16 
217 
1247 
96 
452 
806 
1722 

1.2 
2.1 
1.1 

8.8 

2.7 
10.7 
1.9 

.2 
12.9 

1.2 
1.1 
.1 
1.7 

8.3 
3.0 
4.7 
3.1 
.7 
.4 

.4 
2.3 
.2 
.8 
1.5 
3.2 

1.2 
2.4 
1.2 

7.2 

3.9 

20.1 
3.0 

.2 

18.8 

2.5 
2.4 
.2 
3.4 

16.8 
5.3 
8.1 
5.7 
1.4 
.9 

.6 
3.4 
.3 
2.0 
1.9 
5.4 

1.0 
1.8 
.7 
9.3 

1.9 
2.6 
.3 

.1 
8.9 

t 
t 

1.2 
1.2 
2.3 
.9 
.1 

t 

.1 
1.3 

t 

1.2 
1.2 

1.5 
2.7 
2.0 

8.4 

2.3 

23.2 
8.1 

.7 
13.3 

3.6 
3.4 
.2 

4.8 

17.3 
4.1 
4.6 
5.6 
1.9 
1.1 
.1 
1.5 
4.3 
.5 
.7 
1.9 
7.5 

1.8 

2.0 
2.0 
14.3 

.9 
2.1 
1.5 

.2 
5.3 

.1 

1.6 
.9 
1.3 
.5 
.1 

.5 
1.6 

.1 
.5 
1.4 

Other  acute  poisonings  

Conflagration  

Burns  —  conflagration  excepted  .... 
Absorption  of  deleterious  gases 
—  conflagration  excepted  

Accidental  drowning  

Traumatism  by  firearms  

Traumatism  by  cutting  or 
piercing  instruments  

Traumatism  by  fall     

Traumatism  in  mines  and 
quarries  (total)       

—  in  mines  

—  in  quarries  

Traumatism  by  machines  

Steam  railroad  accidents  and 
injuries  

Street  car  accidents  and  injuries.  .  . 
Automobile  accidents  and  injuries  . 
Injuries  by  other  vehicles  

landslide,  other  crushing  

Injuries  hy  animals  

Starvation       

Excessive  cold    

Effects  of  heat  

Lightning        .        

Electricity  —  lightning  excepted  
Fractures  —  cause  not  specified  .... 
Other  external  violence*  

*  War  deaths  excluded. 

t  Less  than  .05  per  100,000. 

Thus,  among  all  accidents  included  in  the  above  table,  falls 
were  the  most  frequent  of  the  specified  forms  of  violence.     There 


102 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


were  6,917  deaths  from  falling  recorded  among  insured  wage  earn- 
ers over  the  six-year  period  1911  to  1916,  at  a  rate  of  12.9  per 
100,000  exposed.  Accidental  drowning  was  next  in  importance 
with  5,757  deaths  at  a  rate  of  10.7  per  100,000  in  the  six-year 
period  under  observation.  Burns,  excluding  burns  in  conflagra- 
tions, followed  with  4,714  deaths,  or  at  a  rate  of  8.8  per  100,000 
exposed.  Steam  railroad  accidents  and  injuries  showed  4,485 
deaths,  producing  a  rate  of  8.3  per  100,000.  Automobile  accidents 
and  injuries  were  recorded  in  2,507  cases,  with  a  death  rate  of  4.7 
per  100,000  exposed.  A  detailed  discussion  of  the  facts  for  some 
of  the  more  important  of  these  modes  of  injury  in  external  causes 
of  death  follows. 

TRAUMATISM  BY  FALL.* 

We  have  previously  indicated  that  traumatism  by  fall  was  the 
chief  form  of  the  fatal  accidents.  The  6,917  deaths  from  this  con- 
dition corresponded  to  a  rate  of  12.9  per  100,000  exposed.  The 

TABLE  47. 
MORTALITY  FROM  TRAUMATISM  BY  FALL,*  'CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


\ 

rhito. 

c 

olored. 

Age  Period. 

Persons. 

Males. 

Females. 

Males. 

Female*. 

All  ages  —  one  and 
over  

12.9 

18.8 

8.9 

13.3 

5.3 

1  to  4  

10.1 

11.7 

7.7 

19.9 

9  5 

5  to  9  

4.3 

6.1 

2.4 

7.5 

1.9 

10  to  14  

3.1 

4.8 

1.1 

5.1 

2.5 

15  to  19  

3.4 

5.9 

1.0 

5.4 

1.8 

20  to  24  

4.4 

8.8 

.9 

5.6 

2.4 

25  to  34  

7.2 

15.5 

1.9 

8.8 

2.3 

35  to  44  

13.3 

31.3 

3.5 

16.2 

2.6 

45  to  54  

20.9 

42.6 

9.7 

22.1 

5.8 

55  to  64  

39.3 

64.0 

27.2 

37.2 

14.1 

65  to  74  

103.8 

116.5 

105.4 

51.8 

57.5 

75  and  over.  . 

243.9 

208.5 

288.0 

6S.6 

108.9 

*  Falls  from  steam  railroad  trains,  street  cars,  automobiles  and  other 
vehicles,  as  well  as  falls  in  mines  or  quarries,  from  machinery  (travelling 
cranes,  for  example),  and  falls  in  burning  buildings  are  classified  under 
other  headings.  In  short,  not  all  falls  are  classified  under  ' '  Traumatism  by 
fall." 


EXTERNAL  CAUSES  OF  DEATH.  103 

rate  was  highest  for  white  males  and  least  for  colored  females. 
Males  of  both  the  white  and  colored  groups  showed  a  higher  rate 
for  this  cause  of  death  than  did  females.  The  facts  by  age  are 
given  on  page  102. 

The  death  rate  from  traumatism  by  fall  showed  a  high  point  for 
the  ages  1  to  4  years  in  our  experience.  The  rate  for  all  persons 
was  10.1  per  100,000  exposed  in  this  age  group.  This  rate  is  not 
exceeded  in  any  age  period  thereafter  until  the  period  35  to  44 
years  is  reached,  when  it  begins  to  rise  sharply.  For  this  age 
period  a  rate  of  13.3  per  100,000  exposed  is  recorded.  After  a  series 
of  increments  the  maximum  rate  for  any  age  period  is  reached  at 
the  group  of  ages  75  years  and  over  (243.9  per  100,000  exposed). 

The  fatal  accident  rate  for  this  specific  cause  exhibits  the  same 
age  characteristics  for  white  males  as  we  have  pointed  out  for  the 
entire  experience  with  this  exception:  the  rate  for  the  age  group 
1  to  4  years  is  exceeded  by  that  for  25  to  34  years  instead  of  by  thai 
for  35  to  44  years.  For  white  females,  however,  there  seems  to  be  a 
practically  stationary  death  rate  from  this  cause  between  10  and 
24  years.  For  the  ages  thereafter,  a  rapid  increase  in  the  rate  is 
observed.  For  the  highest  age  group  in  our  series  (75  years  and 
over)  the  white  female  fatal  accident  rate  for  this  specific  cause 
exceeds  the  white  male  rate  considerably.  Colored  males,  with 
advancing  age,  show  a  gradually  increasing  death  rate  from  this 
cause,  beginning  with  the  period  10  to  14  years.  Colored  females 
between  20  and  44  years  show  a  fairly  stationary  rate  from  trau- 
matism by  fall. 

The  figures  for  the  individual  years  from  1911  to  1916  do  not 
show  very  marked  differences.  The  highest  rate  was  observed  in 
1913,  13.7  per  100,000,  and  the  minimum  in  1915,  .11.9.  Unlike 
the  acute  infections  and  the  organic  diseases,  we  may  hardly  expect 
a  definite  trend  over  a  short  period  of  years.  The  average  rate  of 
the  six-year  period,  12.9  per  100,000,  may  be  taken  as  a  fair  indi- 
cation of  the  present  incidence  of  this  cause  of  death.  Nor  is  there 
any  very  marked  difference  in  incidence  of  this  condition  among 
the  insured  and  the  general  population,  all  ages  considered.  When 
we  analyze  the  facts  by  age  period,  we  find  that  up  to  age  25  the 
rates  are  very  much  the  same.  Beyond  that  period  the  figures  are 
higher  for  the  insured  group.  This  is  especially  so  among  the 
males  where  the  occupational  factor  is  important  as  a  fruitful 


104 


MORTALITY    STATISTICS   OF    INSURED   WAGE   EARNERS. 


source  of  mortality  among  wage  earners.  Thus,  at  some  age  peri- 
ods of  advanced  life,  such  as  55  to  64  years,  the  rate  is  very  mucli 
higher  among  insured  white  males  than  among  males  in  the  Regis- 
tration Area,  the  rates  being  64.0  and  38.1  per  100,000,  respectively. 

ACCIDENTAL  DROWNING.* 

The  5,757  deaths  from  drowning  during  the  period  1911  to  1916 
correspond  to  a  rate  of  10.7  per  100,000  exposed.  As  might  be 
expected,  the  rate  shows  a  very  marked  difference  for  the  two  sexes. 
The  rate  for  white  males  is  a  little  less  than  eight  times  the  rate 
for  white  females.  Colored  males  show  a  rate  from  this  cause 
more  than  ten  times  the  rate  for  colored  females. 

Deaths  from  Accidental  Drowning  by  Color,  Sex  and  by  Age 

Period. 

The  death  rates  per  100,000  for  accidental  drowning,  according 
to  color,  age  and  sex  classes  are  presented  in  the  following  table : 

TABLE  48. 

MORTALITY  FROM  ACCIDENTAL  DROWNING,*  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AGE  PERIOD. 

Death  Eates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

10.7 

20.1 

2.6 

23.2 

2.1 

1  to  4  

6.2 
10.2 
13.9 
17.0 
12.7 
9.0 
8.0 
9.3 
8.7 
9.1 
9.1 

9.1 
18.6 
23.8 
27.4 
22.0 
17.8 
18.7 
21.5 
21.3 
21.9 
22.7 

3.6 
2.3 
2.7 
4.7 
4.4 
1.7 
1.2 
1.9 
1.3 
1.6 
2.5 

5.8 
10.7 
34.8 
50.2 
30.2 
25.2 
15.6 
16.3 
10.2 
1L7 

1.9 
1.6 
2.8 
2.6 
26 
1.5 
2.1 
2.9 
2.2 
1.2 

5  to  9  

10  to  14  

15  to  19  

20  to  24   
25  to  34  

35  to  44  

45  to  54  

55  to  64   ..    . 
65  to  74  .... 
75  and  over.  . 

•  Under  this  heading  are  classified,  first,  the  deaths  from  drowning  that 
are  known  to  be  accidental  and,  second,  those  which  are  not  definitely  re- 
ported as  accidental  but  which  can  not  be  identified  as  suicidal  or  homicidal. 


EXTERNAL  CAUSES  OF  DEATH.  105 

The  death  rates  for  accidental  drowning  are  highest  for  per- 
sons under  age  25  years.  Considering  all  persons  in  this  experience 
combined,  the  maximum  rate  is  reached  in  the  age  period  15  to 
19  years,  17.0  per  100,000  exposed.  After  this  period,  there  is  a 
decline  in  the  rate  from  this  cause  up  to  and  including  the  period 
35  to  44  years.  After  that  period  we  show  a  slightly  variable  death 
rate,  tending  to  vary  somewhat  around  an  average  of  9.0  per  100,000 
exposed  at  these  ages. 

White  males  show  a  maximum  rate  in  the  period  15  to  19  years 
and  a  declining  rate  thereafter  up  to  and  including  25  to  34  years. 
Between  45  and  74  years,  the  rate  is  almost  stationary  at  a  little 
more  than  21  per  100,000  exposed. 

The  colored  male  statistics  also  show  a  maximum  rate  between 
15  and  19  years  of  age,  50.2  per  100,000  exposed.  The  reader  will 
observe  that  this  rate  is  practically  twice  the  rate  recorded  for  white 
males  between  these  ages.  The  colored  male  rate  is  higher  than 
the  white  male  rate  from  10  years  up  to  and  including  the  age 
period  25  to  34  years,  but  is  lower  thereafter. 

Considering  the  series  of  years  1911  to  1916,  we  are  again  unable 
to  detect  any  distinct  downward  tendency  in  the  death  rate  from 
this  cause.  The  rates  seem  to  vary  but  slightly  from  a  figure  of  a 
little  more  than  10  per  100,000  exposed  for  all  classes  in  the  expe- 
rience. The  highest  death  rate  was  recorded  in  1913,  12.1  per 
100,000,  and  the  lowest  in  1916,  9.7  per  100,000.  During  this 
period  the  death  rate  from  this  cause  showed  two  points  of  maxi- 
mum incidence,  in  1913  and  in  1915.  The  high  rate  for  1913  is 
perhaps  explained  by  the  floods  in  the  Ohio  River  Valley  in  the 
spring  of  that  year.  The  figures  for  1915  result  from  the  inclusion 
of  the  deaths  reported  in  connection  with  the  EASTLAND  disaster  in 
Chicago.  There  were,  in  fact,  171  deaths  of  policyholders  reported 
as  arising  out  of  this  catastrophe. 

The  death  rate  from  drowning  among  white  male  policyholders  was 
higher  at  every  age  period  with  the  exception  of  the  years  under  five 
than  among  males  in  the  general  population.  The  reader  will  ob- 
serve that  a  comparison  of  the  death  rates  for  this  accidental  cause  in 
the  two  experiences  is  first  conditioned  by  the  differences  in  the  areas 
covered  by  the  two  experiences.  It  is  evident  that  for  a  population 
situated  near  water  courses,  where  there  is  opportunity  for  employ- 
ment in  the  pursuits  connected  with  navigation,  one  may  expect  a 


106 


MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


higher  death  rate  for  accidental  drowning.  We  are  not  able  to  say 
whether  the  differences  in  the  hazards  of  accidental  drowning  are 
greater  in  the  localities  covered  by  this  Company  than  in  those 
areas  comprising  the  total  Registration  Area  of  the  United  States. 

BURNS  (CONFLAGRATION  EXCEPTED).* 

The  4,714  deaths  from  burns  in  this  mortality  experience  of  in- 
sured wage  earners  during  the  six-year  period  1911  to  1916  repre- 
sented a  rate  of  8.8  per  100,000  exposed. 

The  rate  for  this  cause  among  white  males  was  lower  than  among 
the  other  three  color  and  sex  classes  of  this  experience.  The  col- 
ored death  rates  for  males  and  females  were  higher  than  the  white 
death  rates  in  the  corresponding  sex  classes.  Colored  females 
showed  a  rate  for  burns  practically  one  acd  one-half  times  that  of 
white  females. 

The  death  rates  according  to  color,  sex  and  age  distinctions  are 
set  forth  in  the  following  table : 

TABLE  49. 

MORTALITY  FROM  BURNS  (CONFLAGRATION  EXCEPTED),*  CLASSIFIED  BY  COLOR, 
SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persona. 

Wlilte. 

Colored. 

Mslee. 

Females. 

Males. 

Females. 

All  agee  —  one  and 
over  

8.8 

7.2 

9.3 

8.4 

14.3 

1  to  4  
5  to  9  

43.8 
10.4 
2.6 
2.1 
3.0 
3.2 
4.3 
6.7 
10.0 
20.3 
41.8 

42.8 
6.7 
1.2 
1.1 
1.7 
1.9 
3.2 
4.6 
5.8 
8.8 
17.0 

40.0 
12.5 
3.7 
2.7 
3.3 
3.7 
4.6 
7.5 
11.4 
23.4 
49.4 

74.3 
9.4 
2.5 
2.6 
3.0 
3.3 
4.6 
3.9 
7.8 
23.4 
41.2 

76.8 
30.1 
7.1 
5.9 
7.7 
5.0 
6.0 
12-.8 
20.7 
55.2 

ns.o 

10  to  14  

15  to  19  

20  to  24    

25  to  34   

35  to  44  .. 

45  to  54  
55  to  64  

65  to  74  

75  and  over.  . 

*  Burns  and  scalds  due  to  railroad,  machinery,  and  mining  accidents, 
as  well  as  those  caused  by  electricity  and  lightning  are  not  classified  under 
this  heading.  This  explains,  to  tome  extent,  the  comparatively  low  rate  for 
males. 


EXTERNAL  CAUSES  OF  DEATH.  107 

The  age  characteristics  of  this  cause  of  death  present  a  maximum 
rate  in  the  entire  experience  at  the  ages  tinder  5  years,  a  decline  to 
a  minimum  between  the  ages  15  to  19  years  and  a  gradual  rise  in 
the  rate  for  succeeding  age  periods  to  a  figure  approaching  the 
maximum  at  ages  75  years  and  over.  The  conformation  of  the 
mortality  curve  for  burns  is  in  general  the  same  for  each  of  the 
color  and  sex  classes  of  this  experience,  although,  as  we  have  pointed 
out,  the  actual  figures  show  considerable  differences. 

From  the  figures  at  hand  no  upward  or  downward  tendency  of 
the  death  rate  for  burns  is  evident. 

The  incidence  of  fatal  burns  is  higher  among  the  insured  than 
in  the  general  population  at  a  number  of  age  periods.  Thus, 
among  insured  white  males,  there  is  an  excess  in  the  ages  under 
10.  and  after  45.  The  figures  for  all  ages  combined  are  in  favor 
of  the  general  population,  6.2  per  100,000  as  compared  with  7.2 
for  insured  white  males.  Comparison  of  the  mortality  facts  for 
burns  among  insured  white  females  and  among  females  in  the 
general  population  shows  no  important  differences  in  the  experi- 
ence of  the  two  groups. 

STEAM  BAILROAD  ACCIDENTS  AND  INJURIES. 

Fatalities  arising  out  of  railroad  accidents  are  an  important  ele- 
ment in  mortality  experiences  generally.  Among  the  wage  earners 
represented  in  this  study  we  recorded  during  the  period  1911  to 
1916,  4,485  deaths  arising  from  railroad  accidents  and  injuries. 
These  deaths  corresponded  to  a  rate  of  8.3  per  100,000  exposed. 
For  colored  males  we  recorded  a  higher  rate,  17.3  per  100,000,  than 
for  white  males,  16.8  per  100,000.  The  colored  female  rate  is 
higher  than  the  corresponding  white  rate,  but  that  for  each  group 
of  females  is  low. 

The  death  rate  from  this  cause  shows  a  minimum  at  the  ages 
under  5  years  and  a  maximum  at  the  highest  age  group  in 
this  discussion.  There  is  a  fairly  progressive  rise  in  the  rate 
by  age  period  throughout  life.  Between  20  and  54  years  of  age, 
however,  there  is  no  upward  tendency.  After  the  latter  age  period 
the  rate  rises  quite  sharply.  The  same  general  age  charateristics 
in  the  mortality  rate  from  this  cause  are  shown  for  white  males 
as  for  the  general  experience.  White  females  show  no  important 


108 


MORTALITY    STATISTICS   OP    INSURED   WAGE   EARNERS. 


mortality  from  this  cause  at  the  ages  under  45  years.     Beyond 
that  age,  however,  a  rising  rate  is  in  evidence  for  this  group. 

The  table  below  exhibits  the  data  for  steam  railroad  accidents 
and  injuries  according  to  the  several  color,  sex  and  age  classes : 

TABLE  50. 

MORTALITY  FROM  STEAM  RAILROAD  ACCIDENTS  AND  INJURIES,  CLASSIFIED 

BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed,     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Female! 

All  ages  —  one  and 
over  

8.3 

16.8 

1.2 

17.3 

1.6 

1  to  4  

1.1 
2.3 
3.5 
8.4 
11.8 
11.3 
10.7 
11.3 
15.6 
17.3 
17.8 

1.5 
3.9 
6.1 
15.2 
25.1 
26.6 
26.7 
27.1 
35.3 
39.4 
34.0 

.7 
.8 
.7 
1.2 
.7 
.7 
.7 
1.7 
3.6 
4.1 
5.9 

.6 
3.6 
7.0 
19.8 
25.0 
20.7 
19.8 
21.5 
27.6 
23.4 
41.2 

.3 
.6 
1.5 
1.1 
1.6 
2.4 
1.8 
2.2 
4.7 
27.2 

5  to  9  

10  to  14  

15  to  19  
20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

Colored  males  show  a  rather  variable  rate  with  age.  There  is  a 
rising  incidence  for  the  ages  under  25  years.  Between  25  and 
74  years  the  rate  tends  to  vary  somewhat  between  20  and  28  per 
100,000  exposed.  Beyond  the  latter  age  period  our  figures  are  not 
of  much  significance.  The  rates  by  age  for  colored  females  are  too 
small  and  too  variable  to  warrant  extended  discussion. 

Considering  the  period  as  a  whole,  there  appears  to  be  a  decrease 
in  the  rate,  especially  among  white  males.  The  three  years,  1914 
to  1916,  however,  show  a  slight  upward  tendency. 

In  the  following  table  we  present  our  data  for  railroad  accidents 
and  injuries  for  single  years  from  1911  to  1916: 


EXTERNAL  CAUSES  OF  DEATH. 


109 


TABLE  51. 
MORTALITY  FROM  STEAM  EAILROAD  ACCIDENTS  AND  INJURIES,  CLASSIFIED  BY 

COLOR  AND  BY  SEX 
Death  Bates  per  100,000  Persons  Exposed.    Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


White. 

Colored. 

Year. 

Persons. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916 

8.3 

16.8 

1.2 

17.3 

1.6 

1916.... 

7.9 

15.3 

1.3 

18.5 

1.8 

1915.... 

7.4 

15.0 

1.0 

16.0 

1.1 

1914.... 

7.5 

15.1 

1.0 

16.0 

1.3 

1913.... 

9.0 

18.8 

1.1 

16.9 

1.2 

1912.... 

9.2 

18.5 

1.4 

17.6 

2.2 

1911.... 

9.5 

19.2 

1.3 

18.6 

2.2 

AUTOMOBILE  ACCIDENTS  AND  INJURIES. 

Automobile  accidents  and  injuries  are  beginning  to  constitute  an 
important  cause  of  accident  fatality.  In  the  six  years  under  dis- 
cussion we  registered  2,507  deaths  from  this  cause.  The  death  rate 

TABLE  52. 

MORTALITY   FROM   AUTOMOBILE  ACCIDENTS  AND  INJURIES,  CLASSIFIED  BY 
COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

4.7 

8.1 

2.3 

4.6 

1.3 

1  to  4  

3.7 
8.6 
5.1 
2.9 
3.2 
3.0 
3.2 
4.4 
7.3 
9.5 
10.1 

4.5 
12.5 
8.5 
4.9 
5.9 
6.4 
6.6 
9.1 
14.1 
18.6 
17.0 

2.9 
4.9 
1.8 
1.2 
1.5 
1.0 
1.6 
2.0 
3.6 
4.5 
6.7 

3.8 
10.4 
6.3 
3.5 
2.0 
2.9 
3.6 
3.3 
7.8 
6.7 
13.7 

1.3 
3.2 
1.6 
.3 
.8 
.9 
.3 
1.8 
2.2 
4.7 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

v  45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

110 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


was  4.7  per  100,000  exposed.  The  highest  death  rate  was  shown 
for  white  males  and  the  least  for  colored  females.  The  color,  sex 
and  age  statistics  for  automobile  accidents  and  injuries  are  shown 
on  previous  page  (Table  52). 

There  is  a  high  point  of  mortality  from  automobile  accidents  and 
injuries  at  each  end  of  the  age  curve.  There  is  one  very  high 
rate  in  childhood  between  5  and  9  years  and  another  in  old  age  at 
the  period  75  years  and  over,  although  the  ages  beginning  with  55 
years  are  all  heavily  weighted  with  automobile  deaths.  Males  of 
both  color  groups  in  this  experience  show  a  higher  death  rate  than 
do  females. 

According  to  our  records  there  is  a  progressively  increasing  death 
rate  year  by  year  from  this  cause.  In  1911  we  recorded  a  rate  of 
2.3  per  100,000  exposed.  In  1916  the  rate  had  increased  to  7.4 
per  100,000.  This  corresponds  to  an  increase  of  221.7  per  cent,  in 
the  rate.  The  following  table  and  Chart  XII  on  page  111  show  the 
general  trend  of  the  death  rate  for  automobile  fatalities : 

TABLE  53. 
MORTALITY  FROM   AUTOMOBILE  ACCIDENTS  AND  INJURIES,   CLASSIFIED  BY 

COLOR  AND  BY  SEX. 
Death  Sates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


• 

Year. 

Persona. 

White. 

Colored. 

Male*. 

Females. 

Males. 

Females. 

1911  to  1916 

1916... 
1915. 
1914  .. 
1913... 
1912... 
1911... 

4.7 

8.1 

2.3 

4.6 

1.3 

7.4 
5.4 
4.8 
4.1 
3.0 
2.3 

12.9 
9.4 
8.5 
7.5 
4.8 
4.0 

3.4 

2.6 
2.4 
1.9 
1.8 
1.1 

8.2 
5.7 
4.2 
3.8 
2.9 
1.9 

2.5 
1.3 
.8 
1.2 

.7 
1.1 

Available  population  mortality  data  show  a  similarly  increasing 
rate  for  automobile  fatalities.  This  fact  calls  for  further  inquiry 
into  the  causes  contributing  to  this  category  of  traffic  accidents, 
especially  in  cities  where  the  growth  of  population  and  the  volume 
of  street  traffic  conduce  to  an  increase  in  liability  to  automobile 
accidents. 


EXTERNAL  CAUSES  OP  DEATH. 


Ill 


Chart  XII. —  Mortality  from  Automobile  Accidents  and  Injuries 

.Death  Rate*  peHOO.OOOPeraon*    Exposed   By   Single  Year*  1911   to  1916 

Experlenoe  of  Metropolitan  Life  Inturanee  Company,  Industrial  Department 
Death  Rate 
per  100.OOO 


1Z 


10 


Co/orcd Malcu 
Co/orecf  FemaJfj. 


Iflff 


112 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


STREET  CAR  ACCIDENTS  AND  INJURIES. 

Fatalities  registered  as  street  car  accidents  and  injuries  in  this 
experience  included  deaths,  not  only  of  persons  riding  on  or  oper- 
ating street  cars,  but  also  those  deaths  on  elevated  and  subway 
trains  and  on  tracks  and  rights  of  way  of  street  railways,  inter- 
urban  roads  operated  electrically,  subways  and  elevated  railroads. 
There  were  registered  1,600  deaths  from  this  cause,  the  correspond- 
ing rate  being  3.0  per  100,000  exposed  in  the  six  years  under  obser- 
vation. The  rate  is  highest  among  white  males  and  least  among 
colored  females. 

There  is  a  fairly  high  rate  for  the  ages  under  5  years  and  a  declin- 
ing one  thereafter  through  the  age  period  20  to  24  years.  After  that 
age  group,  however,  the  rate  increases  up  to  the  maximum  at  the 
highest  age  group  in  our  series.  The  same  general  observations 
apply  to  the  experience  of  white  males  and  white  females.  For  the 
former,  however,  the  age  groups  5  to  9  years  and  20  to  24  years 
show  increases  over  those  immediately  preceding,  while  for  the 
latter  the  decline  continues  through  the  period  25  to  34  years.  The 
data  for  colored  lives  according  to  age  group  are  based  upon  a  small 

TAfeLE  54. 

MORTALITY  FROM  STREET  CAR  ACCIDENTS  AND  INJURIES,  CLASSIFIED   BY 

COLOR,  SEX  AND  BY  AGE  PERIOD. 
Death  Sates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  agee  —  one  and 
over  

3.0 

5.3 

1.2 

4.1 

.9 

1  to  4  

2.7 
2.6 
1.6 
1.6 
1.4 
2.1 
3.1 
4.9 
7.8 
10.3 
22.1 

3.0 
3.6 
2.6 
2.4 
2.7 
4.9 
7.5 
11.1 
15.3 
20.6 
41.1 

2.5 
1.6 
.6 
.5 
.4 
.2 
.5 
1.4 
3.8 
4.4 
12.6 

1.9 

3.2 
1.9 
4.5 
2.0 
3.4 
4.6 
5.2 
9.0 
13.3 
27.4 

1.9 
1.3 
.9 
.6 
.3 
.2 
.8 
2.4 
1.3 
2.3 

5  to  9  

10  to  14  

15  to  19  

20  to  24  
25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

EXTERNAL  CAUSES  OF  DEATH. 


113 


number  of  deaths  under  20  years  of  age  and  there  is,  therefore, 
some  irregularity  in  the  rates  for  the  divisional  periods  of  life. 
From  twenty  years  of  age  upward  among  colored  males  an  increas- 
ing death  rate  from  this  cause  is  found. 

The  table  on  page  112  gives  the  rates  for  street  car  accidents, 
and  injuries  by  color,  sex  and  by  age  period. 

For  the  six  years  under  discussion  a  generally  declining  death 
rate  from  this  cause  is  observed.  This  is  in  contradistinction  to 
the  observed  facts  for  automobile  accidents  and  injuries.  The  fol- 
lowing table  gives  a  view  of  the  trend  of  this  phase  of  the  mortality 
experience  for  the  period  1911  to  1916: 

TABLE  55. 

MORTALITY  FROM  STREET  CAR  ACCIDENTS  AND  INJURIES,  CLASSIFIED   BY 

COLOR  AND  BY  SEX. 

Death  Eates  per  100,000  Persons  Exposed.     Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


. 

White. 

Colored. 

Year. 

Persons. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916 

3.0 

5.3 

1.2 

4.1 

Q 

1916... 

2.6 

4.4 

1.2 

3.5 

.9 

1915... 

2.2 

3.9 

.9 

2.1 

.9 

1914... 

2.7 

4.5 

1.1 

4.2 

1.4 

1913... 

3.6 

6.4 

1.4 

4.6 

1.2 

1912... 

3.5 

6.4 

1.4 

4.6 

.5 

1911... 

3.6 

6.7 

1.3 

5.8 

.5 

INJURIES  BY  OTHER  VEHICLES. 

The  record  of  deaths  from  injuries  by  "other  vehicles"  is  also 
available.  Under  this  group,  1,658  deaths  were  included  arising 
from  accidents  and  injuries  to  passengers,  pedestrians,  drivers  or 
riders  on  wagons,  carriages,  bicycles  and  other  miscellaneous  forms 
of  vehicles  not  motor  driven.  The  rate,  3.1  per  100,000  exposed, 
is  similar  to  that  for  street  car  accidents  and  injuries. 

The  following  table  gives  the  rates  per  100,000  by  color,  sex  and 
age  period: 


9 


in 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


TABLE  56. 

MORTALITY  FROM  INJURIES  BT  OTHER  VEHICLES,  CLASSIFIED  BY  COLOR,  SET 
AND  BT  AOE  PERIOD. 

Death  Bates  per  100,000  Persona  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 
Department. 


Ace  Period. 

Person*. 

White. 

Colored  Males. 

Males. 

Female*. 

All  ages  —  one  and  over. 
1  to  4    

3.1 

5.7 

.9 

5.6 

3.8 
3.8 
1.6 
1.8 
2.0 
2.4 
3.2 
4.6 
5.0 
8.2 
5.3 

4.6 
6.0 
2.8 
3.0 
4.0 
5.6 
7.7 
10.1 
11.4 
16.1 
12.8 

3.2 

1.5 
.5 
.5 
.5 
.3 
.3 
1.0 
.9 
3.1 
.8 

2.6 
5.5 
2.8 
4.5 
2.6 
3.9 
6.0 
10.7 
12.0 
16.7 
13.7 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44       

45  to  54  

55  to  64  

65  to  74  

75  and  over  .... 

There  seems  to  be  a  slight  downward  tendency  in  this  group  of 
specific  causes  of  accidental  injury.  The  following  table  gives  a 
survey  of  the  death  rates  over  the  period  1911  to  1916: 


TABLE  57. 

MORTALITY  FROM  INJURIES  BY  OTHER  VEHICLES,  CLASSIFIED  BY  COLOR  AND 

BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

1911  to  1916  

3.1 

5.7 

.9 

5.6 

1916 

2.8 
3.0 
2.9 
3.4 
3.4 
3.1 

5.4 
5.6 
5.4 
6.4 
6.2 
5.5 

.7 
.8 
.9 
1.4 
.9 
1.0 

6.0 
6.2 
4.4 
3.6 
7.3 
6.0 

1915   

1914   

1913   .      ... 

1912   

1911  

EXTERNAL  CAUSES  OF  DEATH. 


115 


The  death  rate  for  this  group  of  miscellaneous  vehicular  injuries 
is  stationary  for  the  age  periods  under  10  years,  and  declines  to  a 
minimum  rate  between  10  and  14  years.  It  then  gradually  rises 
to  a  maximum  in  the  age  period  65  to  74  years.  There  was  a 
slightly  higher  rate  for  white  males  than  for  colored  males.  White 
females  had  a  low  rate  of  .9  per  100,000  exposed.  The  deaths 
among  colored  females  were  too  few  to  give  any  significance  to  the 
rates.  No  figures  for  this  class  are  therefore  presented. 

TKAUMATISM  BY  MACHINES.* 

A  total  of  905  deaths  from  traumatism  by  machines  is  recorded. 
It  will  be  understood  that  this  title  includes  deaths  by  means  of 
machines  in  most  industries  and  through  mechanisms  such  as  ele- 
vators, which  are  not  always  concerned  in  industrial  processes. 
This  latter  fact  does  not  materially  affect  our  figures,  however,  for 
the  main  working  period  in  life.  The  experience  available,  ac- 
cording to  age  period,  for  all  persons  exposed  to  risk  in  this  investi- 
gation, and  for  white  males  and  colored  males  is  shown  in  the  fol- 
lowing table.  The  experience  for  females  is  not  significant. 

TABLE  58. 

MORTALITY  FROM  TEAUMATISM  BY  MACHINES,*  CLASSIFIED  BY  COLOR  TOR 

MALES,  ANT)  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons  In  Total 
Experience. 

White  Males. 

Colored  Males. 

All  ages  —  one  and  over.  .  .  . 

1.7 

3.4 

4.8 

1  to  14  

.3 

.4 

5 

15  to  19  

2.3 

42 

5  1 

20  to  24  

2.1 

45 

46 

25  to  34  

1.9 

40 

6  5 

35  to  44  

2.7 

67 

6  2 

45  to  54  

3.2 

77 

9  g 

55  to  64  

3.0 

77 

6  6 

65  to  74  

2.3 

60 

1  7 

75  and  over  

1.9 

1.4 

13.7 

*  Deaths  caused  by  machinery  accidents  in  mines  and  quarries  are  classi- 
fied under  title  No.  173  (Traumatism  in  mines  and  quarries) ;  those  due 
to  locomotives  are  charged  to  one  of  the  subtitles  of  title  No.  175  (Steam 
railroad  accidents  and  injuries). 


116 


MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


The  rate  for  white  males  does  not  vary  much  from  the  figure  of 
four  per  one  hundred  thousand  between  fifteen  and  thirty-five  years 
of  age.  The  rate  rises  after  that  age  to  a  figure  of  7.7  per  one  hun- 
dred thousand  between  forty-five  and  sixty-five  years  of  age  and 
declines  thereafter.  The  rates  for  this  cause  of  death  are,  in  gen- 
eral, higher  among  colored  males  than  among  white  males.  The 
maximum  rate  for  colored  males  was  observed  in  the  age  period 
forty-five  to  fifty-four  years,  when  it  was  9.8  per  100,000  exposed. 

There  was  a  fairly  stationary  tendency  in  the  death  rate  from 
this  cause  in  the  present  experience  covering  the  period  1911  to 
1916.  The  following  table  gives  the  facts  for  each  calendar  year 
in  the  investigation : 

TABLE  59. 

MORTALITY  FROM  TRAUMATISM  BY  MACHINES,*  CLASSIFIED  BY  COLOR  FOR 

MALES. 

Death  Bates  per  100,000  Persons  Exposed.     Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona  In  Total 
Experience 

White  Males. 

Colored  Males. 

1911  to  1916  

1.7 

3.4 

4.8 

1916  

1.7 

3.4 

5.3 

1915  

1.4 

2.9 

3.4 

1914  

1.5 

3.3 

2.9 

1913  

2.0 

4.1 

5.4 

1912  

1.7 

3.2 

5.6 

1911  

1.8 

3.4 

6.9 

*  See  footnote  for  Table  58  on  preceding  page. 

A  brief  comparison  of  our  data  with  those  for  the  Registration 
Area  shows  that  for  the  latter  part  of  the  main  working  periods  of 
life  the  death  rate  from  traumatism  by  machines  is  higher  among 
insured  white  males  than  among  males  in  the  corresponding  age 
groups  in  the  Registration  Area  of  the  United  States.  No  precise 
interpretation  can  be  placed  upon  this  fact,  however,  because  we 
do  not  have  any  clue  as  to  the  approximate  number  of  persons  in 
both  experiences  exposed  to  risk  from  machinery.  But  it  is  rea- 
sonable to  assume  that  there  is  a  considerably  larger  proportion 
of  persons  exposed  to  machine  hazards  in  a  group  such  as  that  com- 
prised in  the  insurance  experience  than  there  is  in  the  general 
population  of  the  Registration  Area. 


EXTERNAL  CAUSES  OF  DEATH. 


117 


"OTHER  ACUTE  POISONINGS"*    (Fooo  POISONINGS  EXCEPTED). 

All  accidental  poisonings  in  this  experience  have  been  reported 
under  two  heads:  "poisoning  by  food"  and  "other  acute  poi- 
sonings." The  second  of  these  titles,  which  includes  the  larger 
number  of  these  deaths,  relates  to  those  caused  by  solid  or  liquid 
poisons,  excepting  alkaloid  products  of  putrefaction  and  other  poi- 
sons in  food  products. 

In  this  experience  for  insured  wage  earners  1,144  deaths  from 
this  specific  cause  of  accidental  violence  occurred.  The  rates  are 
slightly  higher  for  the  colored  than  for  the  white  of  each  sex. 

The  age  and  sex  characteristics  for  the  white  group  only  are  given 
in  the  following  table : 


TABLE  60. 

MORTALITY  FROM  ' '  OTHER  ACUTE  POISONINGS,  '  '*  WHITE  PERSONS  CLASSIFIED 

BY  SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persona  In  Total 
Experience. 

White. 

Males. 

Females. 

All  ages  —  one  and  over.  .  .  . 
1  to  4  

2.1 

2.4 

1.8 

7.9 
.8 
.2 
.8 
1.7 
2.2 
2.1 
2.3 
2.7 
3.5 
4.3 

7.6 
1.0 
.3 
.5 
1.4 
2.4 
2.5 
4.3 
4.8 
5.6 
7.1 

7.1 
.5 
.2 
1.2 
1.7 
2.2 
1.9 
1.3 
1.8 
2.5 
3.3 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

"  Other  acute  poisonings  "  show  the  maximum  death  rate  under 
5  years  of  age,  the  minimum  death  rate  between  10  and  14  years 
and  a  fairly  regularly  rising  rate  thereafter.  Between  25  and  54 

*  Deaths  reported  from  ' ' poisoning, "  " carbolic  acid  poisoning, "  "bi- 
chloride of  mercury  poisoning,"  etc.,  although  not  reported  as  accidental, 
are  classified  here  unless  identified  as  due  to  suicide  or  homicide.  Deaths 
caused  by  accidental  inhalation  of  poisonous  gases  are  classified  under 
another  heading;  see  page  119. 


118         MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


years  there  is  a  slackening  in  the  rise  in  the  death  rate.  After  55 
years  of  age  the  rate  rises  again  rapidly.  The  rates  for  males  ex- 
ceed those  for  females  very  generally  throughout  life. 

A  slight  downward  tendency  in  the  death  rate  for  this  cause  is 
in  evidence  recently.  In  1914  the  maximum  rate  (2.6  per  100,000) 
was  registered;  the  minimum  rate  was  1.6  per  100,000  in  1916. 
Considering  the  series  of  years  from  1911  to  1916,  we  may  perhaps 
be  justified  in  concluding  that  recent  efforts  toward  restriction  of 
the  sale  of  poisonous  substances  have  had  some  favorable  influence 
upon  the  death  rate  from  acute  accidental  poisonings.  We  must 
remember,  however,  that  the  recently  increased  tendency  to  specify 
suicidal  and  homicidal  findings  in  cases  which  would  have  been 
formerly  returned  as  undefined  violence,  may  have  had  some  influ- 
ence in  reducing  the  recorded  death  rate  for  acute  accidental  poi- 
sonings. The  following  table  gives  the  death  rates  for  "  Other  acute 
poisonings"  (food  poisonings  excepted)  by  single  calendar  years 
during  the  period  1911  to  1916  classified  according  to  color  and 
sex: 

TABLE  61. 

MORTALITY  FROM  " OTHER  ACUTE  POISONINGS,"*  CLASSIFIED  BY  COLOR  AND 

BY  SEX. 
Death  Eates  per  100,000  Persona  Exposed.     Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

2.1 

2.4 

1.8 

2.7 

2.0 

1916   . 

1.6 
2.0 
2.6 
2.2 
2.3 
2.2 

1.8 
2.2 
3.3 
2.4 
2.4 
2.3 

1.5 
1.5 
2.1 
1.9 
2.1 
2.2 

1.8 

3.4 
3.5 
3.2 
2.5 
1.7 

1.4 
2.4 
2.1 
1.5 
2.4 
2.2 

1915    

1914  

1913     .    ... 

1912  

1911  

*See  footnote  on  page  117. 

The  available  population  experience  also  shows  a  slightly  down- 
ward trend. 


EXTERNAL  CAUSES  OF  DEATH. 


119 


ABSORPTION  OF  DELETERIOUS  GASES.* 

By  far  the  largest  proportion  of  deaths  included  under  this  title 
were  caused  by  accidental  inhalation  of  illuminating  gas.  There 
was,  of  course,  a  significant  number  of  deaths  from  the  absorption 
of  other  poisonous  gases  and  vapors,  such  as  sewer  gas,  anesthetic 
vapors,  and  gases  evolved  in  the  domestic  and  industrial  operation 
of  stoves  and  furnaces. 

The  following  table  gives  the  data  for  this  cause  of  death  with 
respect  to  color,  sex  and  age  classes  of  the  experience: 

TABLE  62. 

MORTALITY  FROM  ABSORPTION  OF  DELETERIOUS  GASES,*  CLASSIFIED  BY  COLOE, 
SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

2.7 

3.9 

1.9 

2.3 

.9 

1  to  4  

1.0 
.7 
.8 
1.1 
1.8 
2.3 
3.4 
5.4 
8.5 
12.2 
20.2 

1.0 
.7 
1.2 
1.2 
2.7 
3.5 
6.8 
10.1 
15.6 
21.0 
28.4 

1.0 
.7 
.4 
1.2 
1.1 
1.5 
1.7 
3.2 
5.7 
8.6 
18.4 

1.3 

.6 
1.0 
1.6 
2.8 
3.6 
5.5 
1.8 
3.3 

1.3 
.3 
.3 
.6 
1.3 
1.5 
.7 
1.0 
.4 
1.2 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  .  .  . 

There  were  1,431  deaths  reported  for  this  cause.  This  number 
of  deaths  represented  a  rate  of  2.7  per  100,000  persons  exposed. 
The  highest  death  rate  was  recorded  for  white  males,  3.9  per  100, 
000,  the  next  highest  for  colored  males,  2.3  per  100,000,  followed 
by  the  rate  for  white  females,  1.9  per  100,000.  The  death  rate 
from  this  cause  among  colored  females  was  .9  per  100,000  of  such 
persons  exposed.  Under  twenty  years  of  age  the  rate  for  both  sexes 
varies  from  .7  to  1.1  per  100,000  persons  exposed.  After  twenty 

*  Deaths  reported  as  due  to  "asphyxia  by  gas,"  "gas  poisoning,"  "il- 
luminating gas  poisoning,"  etc.,  although  not  reported  as  accidental,  are 
classified  here  unless  identified  as  due  to  suicide  or  homicide. 


120         MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


years  of  age  it  rises  gradually  from  a  figure  of  1.8  per  100,000  in 
the  age  group  20  to  24  years  to  20.2  in  the  highest  age  group  in 
this  series.  Under  twenty  years  of  age,  only  one  period  shows  a 
difference  between  the  death  rate  for  this  cause  of  white  males  and 
white  females.  Beginning  with  the  age  period  20  to  24  years,  how- 
ever, the  rate  for  accidental  poisoning  by  deleterious  gases  among 
white  males  was  significantly  higher  than  that  among  white  fe- 
males. Thus,  for  the  age  period  25  to  34  years,  white  males  showed 
a  rate  of  3.5  per  100,000  and  white  females  one  of  only  1.5  per 
100,000.  In  the  two  next  higher  groups  the  excess  of  mortality 
among  males  was  even  more  pronounced.  In  the  age  period  55  to 
64  years  the  death  rate  for  this  cause  among  white  males  was  15.6 
per  100,000  and  among  white  females  5.7  per  100,000.  The  death 
rate  among  colored  males  was  much  higher  after  25  years  of  age 
than  among  colored  females. 

TABLE  63. 

MOBTALITY  FROM   ABSORPTION  OF  DELETERIOUS  GASES,  CLASSIFIED  BY   COLOR 

AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.     Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Mates. 

Females 

1911  to  1916  

2.7 

3.9 

1.9 

2.3 

.9 

1916.  . 

2.9 
2.3 
2.9 
2.5 
3.0 
2.3 

4.5 

3.6 
4.2 
3.4 
4.3 
3.4 

1.8 
1.6 
2.1 
1.9 
2.2 
1.8 

3.3 
1.3 
1.5 
2.2 
3.7 
1.5 

1.4 
.5 
1.3 
1.0 

.7 
.7 

1915  

1914  

1913  

1912  

1911  

The  death  rate  throughout  the  period  1911  to  1916  seems  to  be 
fairly  stationary  for  insured  wage  earners.  It  should  be  recalled 
that  in  former  years  a  fairly  significant  number  of  deaths  from 
illuminating  gas  poisoning  was  registered  under  this  cause  of 
death  title  which,  if  more  modern  methods  of  certifying  causes  of 
death  had  then  been  in  vogue,  would  have  been  recorded  under 
"  suicide  by  asphyxia."  This  factor  of  improvement  in  the  desig- 
nation of  illuminating  gas  deaths  as  suicides  does  not  affect  the 


EXTERNAL  CAUSES  OF  DEATH. 


121 


present  figures  from  1911  onward  as  much  as  it  does  other  figures 
which  refer  back  perhaps  fifteen  years  or  more.  It  should  be 
borne  in  mind,  however,  in  viewing  the  table  on  page  120,  that  this 
matter  of  increased  precision  in  the  certification  of  causes  of  death 
may  have  affected  our  figures  somewhat  and  that  there  may  have 
been,  therefore,  an  actual,  though  slight,  decline  in  the  death  rate 
for  this  cause  of  death. 


TRAUMATISM  BY  FIREARMS.* 

Accidental  deaths  due  to  injury  by  firearms  were  recorded  in 
1,029  cases  in  this  mortality  experience  at  a  rate  of  1.9  per  100,000 
persons  exposed.  This  cause  of  death  has  a  distinct  color  and 
sex  incidence.  The  mortality  rate  among  colored  lives  is  decidedly 
in  excess  of  that  among  white  lives.  Colored  males,  for  instance, 
show  a  rate  of  8.1  per  100,000  as  compared  with  a  rate  of  3.0  for 

TABLE  64. 

MORTALITY  FROM  TRAUMATISM  BY  FIREARMS,*  CLASSIFIED  BY  COLOR,  SEX 
AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over        

1.9 

3.0 

.3 

8.1 

1.5 

1  to  4      

.9 
1.4 
3.2 
4.0 
2.5 
1.8 
1.5 
.6 
.7 
.8 

.9 
1.9 
5.4 
6.0 
3.5 
2.5 
2.2 
1.2 
1.2 
1.5 

.5 
.4 
.3 
.8 
.2 
.1 
.3 
.2 
.2 
.4 

2.6 

5.8 
10.4 
18.5 
13.5 
10.1 
5.2 
.7 
1.8 
1.7 

3.2 
1.6 
1.6 
.6 
3.7 
1.2 
2.0 
.5 

5  to  9      .... 

10  to  14  

15  to  19  

20  to  24  ..... 

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

*  Under  this  title  are  classified,  also,  deaths  reported  from  ' '  gunshot 
wound,"  "shot,''  etc.,  without  qualification  as  to  accidental,  suicidal  or 
homicidal  character.  Every  effort  is  made  to  obtain  definite  information, 
however,  in  such  cases,  and  they  constitute  only  a  small  proportion  of  the 
1,029  deaths  classified  here. 


122         MORTALITY    STATISTICS  OF   INSURED   WAGB  EARNERS. 


white  males.  A  death  rate  of  1.5  per  100,000  is  registered  for  col- 
ored females  and  a  rate  of  only  .3  per  100,000  for  white  females. 
The  table  on  page  121  presents  a  statement  of  the  death  rates  accord- 
ing to  the  several  color,  sex  and  age  classes  in  this  investigation. 

Among  white  males  the  highest  death  rate  for  this  means  of 
injury  occurs  between  15  and  19  years  of  age  with  a  declining 
death  rate  thereafter  up  to  the  advanced  ages  in  this  series.  Among 
colored  males,  also,  the  highest  death  rate  occurs  between  15  and 
19  years  of  age.  It  will  be  noted  also  that  the  death  rate  for  this 
cause  between  5  and  9  years  among  colored  males  (5.8  per  100,000) 
is  almost  as  high  as  the  maximum  rate  for  white  males  (6.0).  A 
very  large  proportion  of  these  deaths  in  late  childhood  and  in  ado- 
lescence are  caused  by  children  playing  with  firearms  and  by  reck- 
less youths  in  the  pursuit  of  sport.  A  considerable  number,  no 
doubt,  are  of  the  "  didn't  know  it  was  loaded  "  type.  At  this  time 
of  life  death  rates  from  all  causes  are  at  a  reasonably  low  level.  A 
further  reduction  of  mortality  in  late  childhood  and  adolescence 
could  be  accomplished,  no  doubt,  by  concentration  upon  the  single 
fact  of  accidental  death  from  firearms. 

TABLE  65. 
MORTALITY  FROM  TRAUMATISM  BY  FIREARMS,  CLASSIFIED  BY  COLOR  AND 

BY  SEX. 
Death  Bates  per  100,000  Persona  Exposed.     Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


White. 

Colored. 

Persons. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

1.9             30 

3 

8  1 

1  5 

1916 

1.9 

3.1 

.3 

8.4 

.8 

1915 

1.7 

2.7 

.4 

5.7 

1.7 

1914 

2.0 

2.7 

.4 

10.2 

1.9 

1913 

2.2 

3.5 

.5 

9.3 

1.5 

1912 

2.0 

3.1 

.3 

7.9 

2.1 

1911 

1.7 

2.8 

.3 

7.3 

1.1 

The  figures  for  the  period  1911  to  1916,  unfortunately,  do  not 
indicate  any  marked  declining  tendency  in  the  death  rate  from  this 
cause.  The  rate  for  each  year  approaches  closely  that  for  the  sex- 
ennium,  1.9  per  100,000  exposed.  In  recent  years  in  the  Registra- 


EXTERNAL  CAUSES  OF  DEATH.  123 

tion  Area  of  the  United  States  a  practically  stationary  death  rate 
has  also  been  observed.  How  far  the  figures  in  each  experience  are 
reliable  for  purposes  of  determining  the  general  trend  of  mortality 
from  accidental  shooting  we  cannot  say  at  present.  A  consider- 
able number  of  deaths  have  been  reported  in  the  more  recent  years 
of  our  experience  as  accidentally  due  to  the  use  of  firearms  which 
would  have  been  reported  in  former  years  in  such  manner  as  to 
justify  tabulation  under  some  indefinite  title  such  as  "Other  ex- 
ternal violence."  The  table  on  page  122  gives  a  brief  view  of  the 
course  of  accidental  mortality  from  firearms  during  the  period  1911 
to  1916. 

ACCIDENT  FATALITIES  AEISING  OUT  OF  OR  IN  THE  COURSE  OF 
EMPLOYMENT. 

The  records  of  accident  mortality  of  insured  wage  earners  pre- 
sent a  very  favorable  opportunity  for  the  collection  of  informing 
statistics  on  fatalities  arising  out  of  or  in  the  course  of  employ- 
ment. We  have  already  observed  in  the  preceding  sections  a  clear 
indication  that  these  industrial  policyholders  suffer  from  higher 
accident  death  rates,  almost  uniformly,  at  ages  where  the  occupa- 
tional factor  plays  a  part.  Provision  was  therefore  made  early  in 
the  course  of  this  study  to  distinguish  and  keep  a  record  of  those 
deaths  where  the  occupation  was  clearly  the  primary  cause  of  the 
accident.  The  period  covered  is  only  five  years,  from  1912  to  1916, 
inclusive.  Although  it  was  not  possible  to  discover  every  case  of 
occupational  origin,  there  is  nevertheless  sufficient  evidence  to  show 
that  the  cases  overlooked  or  disguised  were  relatively  few.  In  order 
to  confine  the  data  to  the  ages  at  which  policyholders  are  gainfully 
employed  the  tabulations  of  deaths  due  to  occupational  violence 
have  been  limited  to  white  males  at  the  ages  15  years  and  over. 

Thus,  between  1912  and  1916,  there  were  recorded  14,151  deaths 
from  a  group  of  selected  and  specific  accidental  causes  of  death, 
in  which  we  might  reasonably  expect  that  occupation  would  play  an 
important  part.  This  number  of  14,151  deaths  does  not,  therefore, 
cover  all  of  the  deaths  from  occupational  violence  among  white 
males  15  years  of  age  and  over.  The  following  table  gives  the  total 
number  of  accidental  deaths  reported  for  the  specified  accidents  and 
injuries  and  the  number  and  percentage  of  deaths  of  occupational 
origin : 


124 


MORTALITY    STATISTICS   OF    INSURED   WAGE   EARNERS. 


TABLE  66. 

NUMBER  or  DEATHS  FROM  SPECIFIED  ACCIDENTAL  CAUSES  or  DEATH  AND 
NUMBER  AND  PERCENTAGE  OP  SUCH  DEATHS  DUE  TO  OCCUPATIONAL 

STRESS. 

White  Males,  Fifteen  Years  of  Age  and  Over,  1918  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Cause  of  Death. 

Total  Deaths 
From  Specified 
Form  of  Violence. 

No.  Deaths  of 
Occupational 
Origin. 

Percent.  Deaths 
of  Occupational 
Origin. 

TOTAL  SPECIFIED  CAUSES  

14,151 

3,963 

28.0 

Conflagration          

149 

23 

15.4 

Burns             

333 

61 

18.3 

Absorption  of  deleterious  gases  

665 

41 

6.2 

Accidental  drowning  

2,381 

151 

6.3 

Traumatism  by  fall  

2,889 

685 

23.7 

Traumatism  in  mines  and  quarries  .  . 
Traumatism  by  machines  

443 
585 

405 
473 

91.4 
80.9 

Railroad  accidents  and  injuries  

2,710 

954 

35.2 

Street  car  accidents  and  injuries  .... 
Automobile  accidents  and  injuries 
Other  vehicular  ace.  and  injuries     .  . 
Other  crushing  ace.  and  injuries  .... 
Injuries  by  animals      

710 
890 
733 
205 
112 

137 
97 
321 
133 
43 

19.3 
10.9 
43.8 
64.9 
38.4 

Electricity  —  lightning  excepted  

323 

200 

61.9 

Fractures  —  cause  not  specified  

311 

4 

1.3 

Other  external  violence  

712 

235 

33.0 

Out  of  the  group  of  accidents  selected  from  this  experience  of 
white  males,  15  years  of  age  and  over,  we  found  28  per  cent,  to 
have  been  certified  as  arising  out  of  or  in  the  course  of  employment. 
For  the  various  types  of  accidents,  or  means  of  injury,  the  per- 
centage of  occupational  deaths  varies.  Thus  for  traumatism  in 
mines  and  quarries  the  highest  percentage  of  occupational  acci- 
dents was  registered,  namely,  91.4.  Under  "absorption  of  dele- 
terious gases  "  there  was  recorded  the  lowest  percentage  for  any  of 
the  definite  types  of  accidental  violence,  6.2.  It  was  found  that  24 
per  cent,  of  the  falls  were  certified  to  have  occurred  in  the  course  of 
the  employment  of  the  deceased.  We  do  not  deem  it  desirable  at 
the  present  time  to  apply  these  ratios  to  any  other  body  of  data 
than  to  the  one  we  have  given.  Our  taMe  and  the  accompanying 
text  will,  it  is  hoped,  stimulate  further  statistical  inquiry,  perhaps 
in  our  published  official  vital  statistics,  into  the  number  and  per- 
centage of  deaths  from  violence  arising  out  of  industry. 

An  interesting  corollary  to  the  foregoing  text  on  the  probable 
number  of  deaths  due  to  occupational  causes,  is  the  comparison  of 


EXTERNAL  CAUSES  OF  DEATH. 


125 


the  variation  from  year  to  year  in  the  ratio  of  deaths  due  to  such 
occupational  stress.  The  following  table  gives  a  survey  of  this 
situation  by  single  years  from  1912  to  1916 : 

TABLE  67. 

MORTALITY  FROM  A  GROUP  OF  SPECIFIED  ACCIDENTAL  CAUSES  OF  DEATH. 
NUMBER  AND  PERCENTAGE  OF  DEATHS  DUE  TO  OCCUPATIONAL  STRESS. 

Single  Years  in  Period  1912  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Total  Deaths  from 
Group  of  Specified 
Accidental  Causes. 

Number  of  Deaths  of 
Occupational  Origin  . 

Per  Cent.  Deaths  of 
Occupational  Origin. 

1912  to  1916     .... 

14,151 

3,963 

28.0 

1916  

3,237 

816 

25.2 

1915  

2,742 

638 

23.3 

1914  

2,683 

777 

29.0 

1913  

2,931 

948 

32.3 

1912  

2,558 

784 

30.6 

It  would  appear,  therefore,  from  these  figures  that  the  proportion 
of  deaths  resulting  from  occupational  accidents  was  on  the  decline 
during  the  five  years  under  observation.  The  increase  in  the  gen- 
eral accident  rate  for  males  at  the  ages  15  years  and  over  must  be 
due  to  other  than  occupational  dangers,  to  which  conclusion  much 
other  evidence  points. 

Trend  of  the  Death  Rate  for  Accidents. 

The  table  on  page  126  gives  the  total  accident  death  rate  from 
1911  to  1916,  qualified  according  to  the  color  and  sex  classes  of 
our  data. 

We  observe  from  the  following  data  a  rather  variable  accident 
death  rate.  The  maximum  figure  in  the  total  experience  was  re- 
corded in  1913  at  77.6  deaths  per  100,000  persons  exposed  and  the 
minimum  in  1915  with  a  rate  of  67.3.  Perhaps  if  we  had  a  longer 
series  of  annual  rates  to  consider,  we  should  be  able  to  detect  a 
slight  tendency  toward  decline  in  the  death  rate  from  accidents  of 
all  kinds.  From  the  figures  at  hand  we  are  unable  to  say  definitely 
whether  there  has  been  any  considerable  reduction  in  the  total  acci- 
dent rate  amon?  insured  wage  earners.  The  conditions  of  grave 
hazard  in  American  life  and  industry  may  not  have  improved, 
therefore,  to  any  great  extent. 


126 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EABNERS. 


TABLE  68. 

MORTALITY   FROM    ACCIDENTAL   AND   UNSPECIFIED   FORMS   OF   VIOLENCE,* 

CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Sates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona. 

WbJte. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

73.0 

115.9 

36.4 

121.4 

38.8 

1916  

73.2 
67.3 
69.9 
77.6 
73.8 
77.4 

118.7 
105.8 
109.3 
124.9 
115.2 
123.6 

34.8 
34.7 
36.5 
37.2 
37.2 
38.8 

122.7 
108.5 
118.2 
134.8 
128.4 
116.5 

37.5 
37.7 
35.5 
39.6 
41.2 
41.6 

1915  

1914  

1913  

1912  

1911  

*  War  deaths  excluded. 

For  white  females  and  for  colored  females  we  are  able  to  detect  a 
fairly  consistent  but  slight  downward  trend  of  total  accidents. 
This  is  perhaps  an  indication  that  the  graver  hazards  which  sur- 
round women  in  home  life  have  been  mitigated  in  part  by  the 
various  educational  and  other  efforts  toward  security  of  the  person 
from  accidental  violence.  The  white  male  total  accident  rate 
fluctuates  somewhat  from  year  to  year  and  from  a  view  of  the 
figures  in  our  present  series  we  do  not  feel  able  to  say  that  there 
has  been  any  marked  change  for  better  or  worse  in  the  accident 
situation  as  it  affects  this  group.  The  colored  male  total  accident 
rate  likewise  offers  no  particularly  encouraging  evidence  that  the 
graver  general  accident  hazards  surrounding  wage  earners  have  been 
mitigated  to  any  great  extent. 

SuiCIDES.f 

The  suicide  problem  has  in  recent  years  attained  considerable 
prominence  in  discussions  of  the  aims  and  purposes  of  preventive 

f  Under  "Suicides"  are  classified  only  those  cases  in  which  the  fact  of 
suicide  or  of  attempt  at  suicide  is  clearly  shown.  By  careful  "editing" 
of  our  data  relating  to  cause  of  death,  hundreds  of  cases  originally  re- 
ptrted  under  such  terms  as  "poisoning,"  "inhalation  of  gas,"  "drown- 
ing," "gunshot  wound,"  "cut"  and  others  have  been  added  to  this 
title  instead  of  being  placed  under  the  class  "accidental  or  unqualified." 


EXTERNAL  CAUSES  OF  DEATH. 


127 


medicine.  Suicide  is  often  a  preventable  source  of  mortality,  espe- 
cially when  it  is  recalled  that  in  many  cases  the  suicidal  impulse  is 
the  end  product  of  a  psychosis,  which,  if  treated  in  good  time,  might 
have  been  relieved.  That  suicide  is  a  serious  source  of  mortality  is 
indicated  by  the  fact  that  in  the  six-year  period  of  this  experience 
6,542  deaths  from  this  cause  were  recorded.  Interest  attaches  also 
to  this  mass  of  deaths  because  they  have  occurred  among  a  group 
of  wage  earners.  If,  as  has  been  supposed,  the  suicide  death  rate 
is  a  measure  of  the  mental  health  of  a  people,  the  figures  at  our 
disposal  should  help  us  determine  an  important  characteristic  of 
the  American  industrial  population  in  relation  to  that  of  other 
groups  of  the  population.  In  the  following  table  we  present  a 
statement  of  the  suicide  death  rates  for  each  of  the  color  and  sex 
classes  of  our  data.  Chart  XIII  graphically  illustrates  these  age 
data. 

TABLE  69. 

MORTALITY  FROM  SUICIDE   (ALL  FORMS),  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AGE  PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Male. 

Female. 

Male. 

Female. 

All  ages  —  one  and 
over        

12.2 

20.1 

6.8 

10.1 

4.9 

1  to  14  

.1 
6.0 
13.0 
17.0 
20.9 
26.5 
31.3 
34.0 
34.1 

.2 
5.0 

18.0 
27.9 
42.9 
60.1 
72.8 
79.7 
86.5 

.1 

7.2 
8.7 
11.1 
10.9 
11.1 
10.4 
10.5 
8.4 

.3 

5.1 
14.8 
16.3 
14.8 
12.7 
15.6 
10.0 

.3 
5.3 
11.9 
7.4 
5.7 
3.4 
1.3 
1.2 

15  to  19.  .    .. 
20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  . 

At  all  ages  combined,  the  rate  was  12.2  per  100,000  persons  ex- 
posed. The  group  of  white  males  shows  the  highest  rate  of  any  of 
the  color  or  sex  classes,  followed  by  colored  males,  by  white  females 
and  finally  by  colored  females.  Males  of  each  color  group  show 
decidedly  higher  suicide  rates  than  do  females. 


128          MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


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EXTERNAL  CAUSES  OF  DEATH.  129 

Suicide  Mortality  According  to  Color,  Sex  and  Age. 

The  age  characteristics  of  these  suicide  data  are  also  of  signifi- 
cance. Beginning  with  a  rate  of  6.0  per  100,000  between  15  and 
19  years,  we  recorded  a  rising  rate  up  to  and  including  the  highest 
significant  age  period,  65  to  74  years.  The  age  group  75  years  and 
over  has  been  disregarded  because  of  its  heterogeneous  age  com- 
position and  the  small  number  of  lives  exposed  and  of  deaths  re- 
ported. This  gradual  upward  slope  of  the  curve  for  suicide  mor- 
tality probably  reflects  very  largely  the  experience  of  the  white 
male  group  included  in  the  figures  for  all  persons.  For  white 
males  there  is  quite  a  sharp  rise  in  the  curve  of  suicide  mortality, 
from  a  figure  of  5.0  per  100,000  between  the  ages  15  and  19  years 
to  a  rate  of  79.7  per  100,000  at  the  age  period  65  to  74  years. 
White  females  do  not  show  as  clearly  this  phenomenon  of  increas- 
ing suicide  mortality  with  age.  Beginning  with  a  figure  of  7.2 
per  100,000  at  the  age  period  15  to  19  years,  there  is  a  gradual  in- 
crease to  a  rate  of  11.1  for  the  age  period  25  to  34  years.  From 
this  group  up  to  and  including  the  period  65  to  74  years  there  is  a 
practically  stationary  suicide  rate  for  white  females,  with  little 
variation  from  a  figure  of  10.5  per  100,000. 

The  suicide  rate  for  colored  males  does  not  show  any  tendency 
throughout  the  entire  range  of  life  toward  either  a  decrease  or  an 
increase  with  advancing  age.  After  the  age  period  20  to  24  years 
for  colored  females,  we  observe  a  distinct  drop  in  the  suicide  rate 
with  advancing  years,  from  a  figure  of  11.9  per  100,000  in  the  first 
named  age  period  to  a  rate  of  3.4  per  100,000  in  the  period  45  to 
54  years,  the  last  age  group  for  which  we  have  significant  figures. 

In  view  of  the  importance  of  racial  characters  of  suicide  mor- 
tality, it  will  be  of  some  interest  to  consider  the  comparative  ratios 
of  some  of  these  mortality  rates  for  the  several  color  classes  by  sex 
and  age. 

Ratio  of  Suicide  Mortality  by  Color. 

In  a  preceding  section  we  indicated  the  lower  suicide  mortality 
rate  among  colored  persons.  The  colored  male  suicide  rate  was 
only  50  per  cent,  of  that  shown  for  white  males  at  all  ages  combined. 
But  this  relation  varies  markedly  at  the  several  age  periods.  Be- 
tween 15  and  19  years  our  figures  indicate  a  slight  excess  in  the 
colored  male  suicide  rate  over  the  rate  for  white  males,  but  this  may 
be  purely  accidental  and  of  no  real  significance.  Beginning  with 
10 


130 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


the  age  period  20  to  24  years,  the  colored  male  suicide  rate  becomes 
increasingly  more  favorable  in  respect  to  the  white  male  rate. 
Thus,  while  colored  males  showed  a  suicide  mortality  rate  82.2  per 
cent,  of  that  recorded  for  white  males  at  the  age  period  20  to  2-i 
years,  the  ratio  was  only  12.5  per  cent,  at  the  age  period  65  to  74 
years.  Among  colored  females  also,  with  the  exception  of  the  age 
period  20  to  24  years,  we  observe  with  advancing  age  an  increas- 
ingly more  favorable  suicide  rate.  The  foregoing  facts  are  shown 
in  the  table  given  below : 

TABLE  70. 

MORTALITY  FROM  SUICIDE  (ALL  FORMS). 
Percentage,  Colored  of  White  Mortality  at  Specified  Age  Periods  for  Each 

Sex.     1911   to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Percentage,  Colored  of  White  Mortality. 

Males. 

Females. 

All  age8—  one  and  over  

50.2 

72.1 

15  to  19     

102.0 
82.2 
58.4 
34.5 
21.1 
21.4 
12.5 

73.6 
136.8 
66.7 
52.3 
30.6 
12.5 
11.4 

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

Sex  Ratio  of  Suicide  Mortality. 

We  have  shown  that  for  white  persons,  the  female  suicide  rate  was 
less  than  the  male  suicide  rate,  the  ratio  being  about  one  to  three. 
White  males  show  a  higher  rate  of  self-destruction  at  all  age  periods 
with  the  exception  of  the  period  of  15  to  19  years. 

There  is  a  distinctly  higher  suicide  rate  among  white  females  in 
this  age  of  early  adolescence  than  among  white  males.  This  phe- 
nomenon is  also  in  evidence  in  such  population  figures  as  we 
have  been  able  to  find.  It  is  possible  that  the  stress  and  strain 
of  early  adolescence  is  more  disastrous  to  females  than  to  males. 
We  might  expect,  also,  to  find  a  higher  index  of  mental  disorders 
among  female  adolescents  than  among  males  of  the  same  ages  on 
the  basis  of  these  suicide  data.  It  may  be  noted  in  this  connec- 
tion that  there  is  a  much  higher  incidence  rate  of  serious  cases  of 


EXTERNAL  CAUSES  OF  DEATH. 


131 


dementia  precox,  a  form  of  dementia  characteristic  of  adolescence 
and  early  adult  life,  among  females  than  among  males  in  popula- 
tions generally.  Thus,  in  New  York  State  during  1916  there  were 
in  the  care  of  the  hospitals  for  mental  diseases  under  the  super- 
vision of  the  New  York  State  Hospital  Commission,  8,903  male  and 
10,046  female  dementia  precox  cases.  At  the  ages  in  the  popula- 
tion from  which  these  patients  were  drawn,  there  is  a  considerable 
excess  of  males.  This  would  make  the  disparity  between  the  male 
and  female  dementia  precox  rates  much  greater  than  would  be 
indicated  by  the  foregoing  comparison  of  the  sex  ratios  of  such 
patients  under  hospital  care. 

Beginning  with  the  age  period  20  to  24  years,  the  white  male 
suicide  rate  shows  a  very  marked  excess  over  the  white  female  rate. 
This  excess  increases  with  advancing  age.  Between  20  and  24 
years  the  white  male  suicide  rate  is  207  per  cent,  of  the  white  female 
rate,  between  25  and  34  years,  251  per  cent.;  between  35  and  44 
years,  394  per  cent.,  increasing  to  a  percentage  of  759  at  the  age 
period  65  to  74  years. 

TABLE  71. 
MORTALITY  FROM  SUICIDE    (ALL  FORMS). 

Percentage,  Male  of  Female  Mortality  at  Specified  Age  Periods  for  Each 
Color  Class.     1911   to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Percentage,  Male  of  Female  Mortality. 

White. 

Colored  . 

All  ages  —  one  and  over  

295.6 

206.1 

15  to  19   . 

69.4 
206.9 
251.4 
393.6 
541.4 
700.0 
759.0 
1029.8 

96.2 
124.4 
220.3 
259.6 
373.5 
1200.0 
833.3 

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

Colored  males  also  show  a  suicide  death  rate  lower  than  that  for 
colored  females  at  the  age  period  15  to  19  years,  although  the 
advantage  of  the  males  in  relation  to  the  females  among  the  colored 
is  not  as  great  as  that  observed  among  the  white  lives.  Beginning 
with  the  age  period  20  to  24  years  colored  males  showed  a  suicide 


132          MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 

rate  124  per  cent,  of  that  recorded  for  colored  females.  There  is 
much  the  eame  precipitate  rise  in  the  percentage  of  excess  of  male 
suicide  mortality  among  colored  persons  as  we  found  among  white 
persons.  The  greatest  difference  is  found  in  age  period  55  to  64 
when  the  rate  for  colored  males  is  twelve  times  as  high  as  for  col- 
ored females.  The  foregoing  observations  are  shown  in  tabular 
form  on  page  131. 

Suicide  Experience  of  Insured  Wage  Earners  and  Population  of 
Expanding  Registration  Area  of  the  United  States  Compared. 

The  suicide  rates  for  white  male  insured  wage  earners  are  more 
favorable  than  the  rates  for  males  in  the  general  population  of  the 
United  States  only  for  the  ages  under  25  years.  Beginning  with 
the  age  period  25  to  34  years  we  observe  excesses  in  the  suicide  rate 
of  white  male  wage  earners — an  excess  of  5  per  cent,  for  the  period 
25  to  34  years,  of  20  per  cent,  for  the  period  35  to  44  years,  of  17 
per  cent,  for  the  period  45  to  54  and  of  11  per  cent,  for  the  period 
55  to  64  years.  In  other  words,  at  the  ages  of  early  adolescence 
and  early  adult  life  white  male  wage  earners  show  a  more  favorable 
suicide  rate,  but  continuing  through  the  main  working  period  of 
life  and  up  to  the  last  age  group  registered  in  this  table,  the  suicide 
rate  of  insured  white  males  exceeds,  and  rises  faster,  than  the  rate 
for  all  males  in  the  general  population  of  the  expanding  Registra- 
tion Area  of  the  United  States. 

The  suicide  experience  for  insured  white  females  is,  however, 
more  encouraging.  Only  between  the  ages  15  and  19  years  and  25 
and  34  years  do  we  find  an  excess  (very  negligible)  in  the  suicide 
rate  of  the  insured  group  over  females  in  the  general  population. 
For  all  other  age  periods,  insured  white  females  show  a  more  favor- 
able suicide  rate  than  do  females  in  the  population  of  the  expand- 
ing Registration  Area  of  the  United  States.  Moreover,  between 
the  ages  35  to  64  years,  insured  white  females  show  a  tendency  to 
improve  upon  the  already  favorable  ratio  of  their  suicide  rate  to  the 
rate  for  females  in  the  general  population.  Between  35  and  44 
years  insured  white  females  showed  a  rate  96.5  per  cent,  of  that 
recorded  for  females  in  the  general  population ;  between  45  and  54 
years,  a  rate  of  88.8  per  cent.,  and  between  55  and  64  years,  a  rate 
78.2  per  cent,  of  that  recorded  for  females  in  the  general  population. 
These  observations  are  shown  in  the  following  table : 


EXTERNAL  CAUSES  OF  DEATH. 


133 


TABLE  72. 
MORTALITY  FROM  SUICIDE   (ALL  POEMS). 

Death  Sates  pet  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Age  Period. 

Males. 

Females. 

M.  L.  I.  CO. 

(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 

(White). 

. 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Are*. 

All  ages  —  one 
and  over  .... 

1  to  14 
15  to  19 
20  to  24 
25  to  34 
35  to  44 
45  to  54 
55  to  64 
65  to  74 
75  and  over. 

20.1 

24.6 

81.7 

6.8 

7.9 

86.1 

.2 

5.0 
18.0 
27.9 
42.9 
60.1 
72.8 
79.7 
86.5 

.6 
5.6 
18.2 
26.7 
35.8 
51.4 
65.8 
61.6 
61.5 

33.3 
89.3 
98.9 
104.5 
119.8 
116.9 
110.6 
129.4 
140.7 

.1 
7.2 

8.7 
11.1 
10.9 
11.1 
10.4 
10.5 
8.4 

.5 
7.1 
10.7 
11.0 
11.3 
12.5 
13.3 
11.6 
9.8 

20.0 
101.4 
81.3 
100.9 
96.5 
.    88.8 
78.2 
90.5 
85.7 

Suicide  According  to  Principal  Means  of  Injury. 

The  above  discussion  reviewed  the  principal  facts  of  the  suicide 
experience  in  the  aggregate.  A  more  intimate  view,  however,  is 
afforded  by  a  brief  consideration  of  this  phenomenon  of  self- 

TABLE  73. 

MORTALITY  FROM  SUICIDE   (ALL  FORMS). 
Number  of  Deaths,  and  Percentage  of  Deaths  According  to  Specified  Means 

of  Injury.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Means  of  Injury. 

Number  of  Deaths. 

Percentage  of  Total. 

SUICIDES  —  TOTAL  

6,542 

100.0 

Suicide  by 
Poison  

2,352 

36.0 

Asphyxia  

1,040 

15.9 

Hanging  or  strangulation  . 
Drowning        

761 
316 

11.6 

4.8 

Firearms  

1,519 

23.2 

Cutting  or  piercing 
instruments  

346 

5.3 

Jumping  from  high  places. 
Crushing  

107 
33 

1.6 
.5 

Other  suicides  

68 

1.0 

134          MORTALITY    STATISTICS  OP  INSURED   WAGE   EARNERS. 

destruction  according  to  the  means  of  injury  employed.  In  the 
preceding  table  we  display  the  number  of  deaths  reported  accord- 
ing to  the  chief  means  of  injury  employed,  and  the  percentage  that 
each  "means  of  injury"  class  constitutes  of  the  total. 

Poison  was  the  chief  means  of  suicide  in  the  present  experience. 
Of  the  total  deaths  from  suicide,  36.0  per  cent,  were  accomplished 
by  this  means.  This  ratio  is,  of  course,  not  constant  in  all  mor- 
tality experiences.  For  instance,  in  New  York  City,  asphyxia  is 
the  principal  mode  of  committing  suicide  for  both  males  and  fe- 
males and  in  the  Registration  Area  of  the  United  States  it  would 
seem  that  firearms  were  the  chief  means  of  suicidal  injury  as  re- 
gards males.  Poisoning  seems  to  be  the  mode  most  frequently 
chosen  by  females  in  the  Registration  Area,  corresponding  prac- 
tically to  the  prevalence  shown  in  the  experience  of  the  Industrial 
Department  of  this  Company.  Variation  in  the  choice  of  means 
of  suicidal  injury  depends,  of  course,  upon  numerous  factors,  such 
as  legislative  restriction  upon  the  sale  of  poisons,  firearms  and  other 
means  of  injury,  the  extent  to  which  publicity  is  given  to  suicides 
in  the  newspapers  of  various  localities,  and  other  strictly  local  fac- 
tors difficult  to  enumerate.  We  shall  take  up  briefly  the  principal 
means  of  suicidal  injury  in  this  present  experience. 

Suicide  ly  Poison* 

There  were  2,352  deaths  from  this  cause  concerned  in  the  present 
investigation,  in  which  either  solid  or  liquid  poisonous  substances 
were  employed.  These  deaths  corresponded  to  a  rate  of  4.4  per 
100,000  persons  exposed.  The  age  and  sex  characteristics  of  this 
cause  of  death  are  shown  in  Table  74  on  page  135. 

It  will  be  seen  that  the  maximum  rate  in  the  entire  group  for 
suicide  by  poison  is  that  among  white  males  in  the  age  period  55 
to  64  years.  Among  white  females  and  colored  males,  the  maxi- 
mum figure  is  found  in  the  age  period  25  to  34  and  amonsr  colored 
females  even  earlier,  between  20  and  24  years. 

The  general  trend  of  mortality  from  suicide  by  poison  seems  to 
be  downward.  This  is  indicated  by  the  figures  given  in  Table  75 
on  page  135. 

*  Solid  and  liquid  poisons  only.  Where  poisonous  gas  is  the  means  em- 
ployed the  death  is  classified  under  "Suicide  by  Asphyxia." 


EXTERNAL  CAUSES  OF  DEATH. 


135 


TABLE  74. 
MORTALITY  FROM  SUICIDE  BY  POISON,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over        

4.4 

6.0 

3.4 

2.9 

3.0 

1  to  14  

3.3 

6.2 
7.7 
7.5 
7.3 
8.1 
7.3 
3.8 

1.7 
6.7 
10.7 
14.1 
15.0 
17.6 
16.7 
8.5 

.1 

5.0 
5.9 
6.3 
4.5 
4.0 
3.7 
2.7 
1.7 

.1 
1.3 
3.0 
6.2 
4.8 
3.3 
1.8 

3.8 
8.5 
4.9 
3.1 
1.0 
.4 

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  . 

t  Less  than  .05  per  100,000. 

From  a  rate  of  5.4  per  100,000  in  1911  the  decline  was  fairly 
regular  to  a  rate  of  2.8  per  100,000  in  1916.  We  must  remember, 
however,  that  suicide  mortality  is  subject  to  considerable  fluctua- 
tion with  community  conditions  and  that  an  opinion  on  the  real 
trend  of  this  phenomenon  must  be  founded  upon  facts  over  a  long 

TABLE  75. 
MORTALITY  FROM  SUICIDE  BY  POISON,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.  Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916 

1916.... 
1915.... 
1914.... 
1913.... 
1912.... 
1911.  ... 

4.4 

6.0 

3.4 

2.9 

3.0 

2.8 
3.8 
4.8 
5.1 
4.8 
5.4 

3.5 
4.9 
6.8 
7.1 
6.6 
7.7 

2.4 
3.4 
3.4 
3.7 
3.7 
4.1 

2.4 
.9 
3.7 
4.6 
4.1 
1.9 

1.8 
2.8 
3.7 
3.1 
2.4 
4.1 

136 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


period  of  time  and  only  after  the  fluctuations  characteristic  of  sui- 
cide are  in  full  view. 

Suicide  by  Asphyxia. 

The  experience  for  this  cause  of  death  among  white  males  and 
females  according  to  age  periods  is  shown  in  the  following  table. 
No  substantial  facts  for  colored  persons  are  available. 

TABLE  76. 

MORTALITY  FROM  SUICIDE  BY  ASPHYXIA,  CLASSIFIED  BY  SEX  FOB  WHITE 
LIVES  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persona  In  Total 
Experience. 

White. 

Males. 

Females. 

All  ages  —  one  and  over  .... 
1  to  24  .  . 

1.9 

3.0 

1.5 

.3 
2.2 
3.9 
5.3 
6.2 
6.7 
3.4 

.3 
3.4 
6.3 
10.4 
13.3 
14.4 
5.7 

.2 
2.1 
3.6 
3.6 
2.8 
3.0 
2.5 

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

The  rates  represented  in  the  foregoing  table  were  based  upon 
1,040  deaths  from  suicide  by  asphyxia.  The  rate  for  males  from 
this  cause  is,  at  all  ages  combined,  twice  as  high  as  that  for  white 
females.  There  is  a  constant  increase  in  the  rate  with  age  for 
white  males  throughout  the  significant  age  groups  but  no  very 
material  variation  for  white  females.  The  general  trend  of  the 
rate  for  suicide  by  asphyxia  during  the  six  years  under  observa- 
tion is  shown  in  the  table  on  page  137. 

There  is  a  practically  constant  death  rate  for  this  cause.  Such 
variations  as  do  occur  are  of  no  particular  moment.  If  anythinsr, 
there  seems  to  be  a  slight  increase  in  the  rate  for  white  females. 
In  the  expanding  Registration  Area  of  the  United  States,  also, 
there  has  been  observed  in  recent  years  a  slisrht  increase  in  the  re- 
corded death  rate  from  suicide  by  asphyxia,  but  this  may  be  almost 
entirely  due  to  an  increase  in  the  precision  of  reporting  on  the  part 
of  coroners,  physicians  and  others  entrusted  with  the  completing  of 
death  certificates. 


EXTERNAL   CAUSES  OF  DEATH. 


137 


TABLE  77. 
MORTALITY  FROM  SUICIDE  BY  ASPHYXIA,  CLASSIFIED  BY  SEX  roa  WHITE 

LIVES. 
Death  Sates  per  100,000  Persons  Exposed.     Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons  In  Total 
Experience. 

White. 

Males. 

Females. 

1911  to  1916  

1.9 

3.0 

1.5 

1916  

1.9 
2.3 
1.9 
2.1 
1.7 
1.7 

2.5 
3.4 
3.1 
3.5 
2.4 
2.8 

1.8 
1.9 
1.2 
1.5 
1.5 
1.1 

1915  

1914  

1913  

1912  

1911  

Suicide  by  Hanging  or  Strangulation. 

Only  761  deaths  from  this  cause  were  recorded.  This  number 
does  not  justify  any  detailed  analysis  according  to  age  classes.  It 
will  be  sufficient  to  remark  that  the  death  rate  for  this  cause  was 
practically  the  same  among  white  males  as  the  death  rate  from  sui- 
cide by  asphyxia.  For  white  females  and  for  colored  persons  the 
data  are  of  no  significance.  The  total  number  of  deaths  registered 
was  761;  of  these  626  were  those  of  white  males. 

Suicide  by  Drowning. 

There  were  only  316  deaths  from  this  form  of  suicide.  White 
males  showed  the  highest  rate ;  white  females  had  a  death  rate  about 
half  that  of  white  males. 

Suicide  by  Firearms. 

The  use  of  firearms  was  next  in  importance  to  poison  among  the 
cases  of  suicide  represented  in  this  mortality  experience.  We  re- 
corded in  all  1,519  deaths  at  a  rate  of  2.8  per  100,000  exposed. 
The  mortality  rate  varied  quite  sharply  according  to  sex,  there  being 
an  almost  negligible  rate  among  females  of  both  color  or  race 
classes.  Our  facts  for  color,  sex  and  age  are  given  in  the  following 
table: 


138 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


TABLE  78. 
MORTALITY  FROM  SUICIDE  BY  FIREARMS,  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AGE  PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Ag*  Period. 

Persons. 

White. 

colored. 

Males. 

Females  . 

Males. 

Female*. 

All   ages  —  one  and 
over  

2.8 

5.7 

.6 

4.2 

.8 

1  to  14  

1.3 
4.1 
3.9 
4.7 
6.1 
6.6 
6.0 
7.2 

.1 

1.9 
7.3 
8.1 
11.7 
16.5 
17.8 
16.5 
21.3 

.8 
1.5 
1.0 
.9 
.7 
.4 
.3 

.1 

1.9 
7.9 
7.2 
5.6 
5.2 
4.8 
3.3 

.1 

.6 
1.1 
1.3 
1.0 
.8 
.4 

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

t  Less  than  .05  per  100,000. 

The  chief  fact  of  importance  in  this  table  is  the  practically  sta- 
tionary rate  between  45  and  75  years  of  age.  The  trend  of  the 
mortality  from  this  cause  is  displayed  in  the  following  table : 

TABLE  79. 

MORTALITY  FROM  SUICIDE  BY  FIREARMS,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Sates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

WtoitC. 

Colored. 

Males. 

Females. 

Male*. 

Females. 

1911  to  1916  

2.8 

5.7 

.6 

4.2 

.8 

1916..  . 

2.5 
2.8 
2.7 
3.1 
2.9 
3.0 

4.8 
5.5 
5.4 
6.5 
6.1 
5.9 

.6 
.6 

.7 
.6 
.4 
.5 

4.2 
4.3 
3.7 
4.2 
5.0 
4.1 

.6 
.9 
.8 
.5 
.5 
1.3 

1915  

1914  

1913  

1912  

1911.. 

The  figures  at  hand  relate  to  so  few  calendar  years  that  no  final 
conclusion  can  be  drawn  on  the  general  trend  of  suicide  by  firearms. 


EXTERNAL  CAUSES  OF  DEATH.  139 

We  can  say  at  a  venture  that  a  slight  decrease  was  observed.  The 
underlying  causes  of  mortality  from  suicide  by  firearms  are  en- 
tirely too  complex  to  make  it  possible  for  us  to  speculate  in  any 
great  detail  upon  the  data  shown  in  the  foregoing  table. 

HOMICIDE.* 

The  facts  on  homicide  among  this  group  of  insured  wage  earners 
form  an  important  contribution  to  the  statistics  on  the  crime  of 
homicide  in  the  United  States.  In  fact,  there  are  not  available  in 
discussions  of  the  homicide  problem  any  such  detailed,  modern  data 
according  to  age  classes  of  the  two  main  race  groups  in  the  popu- 
lation as  are  to  be  found  in  this  present  display.  In  this  investi- 
gation there  were  recorded  3,753  homicides  and  these  deaths  rep- 
resent a  rate  of  7.0  per  100,000  persons  exposed.  The  following 
table  gives  a  statement  of  the  number  and  percentage  of  homicide 
deaths  according  to  the  several  means  of  injury  employed: 

TABLE  80. 
MORTALITY  FROM  HOMICIDE  (ALL  FORMS).* 

Number   of   Deaths,    and   Percentage   of   Deaths,    According   to    Specified 
Means  of  Injury.     1911   to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Means  of  Injury. 

Number  of  Deaths. 

Percentage  of  Total. 

HOMICIDES  —  TOTAL  

3753 

100.0 

Firearms  

2435 

64.9 

Cutting  or  piercing 
instruments  

616 

16.4 

Other  homicides  

702 

18.7 

Of  these  homicides,  64.9  per  cent,  were  accomplished  through 
the  use  of  firearms.  This  proportion  is  slightly  in  excess  of  that 
for  the  general  population  of  the  expanding  Registration  Area 
(61.8).  Homicide  by  means  of  cutting  or  piercing  instruments 

*  Under  ' '  Homicide ' '  are  classified  only  those  cases  in  which  the  fact  of 
homicide  or  of  attempt  at  homicide  is  clearly  shown.  By  careful  "editing" 
of  our  data  relating  to  causes  of  death  many  cases  originally  reported 
under  such  terms  as  ' '  gunshot  wound, "  "  cut, "  "  poisoning, ' '  and  others 
have  been  classed  as  homicides  instead  of  being  placed  under  the  "acci- 
dental or  unqualified"  group. 


140 


MORTALITY    STATISTICS   OP    INSURED    WAGE    EARNERS. 


was  recorded  in  the  present  investigation  in  16.4  per  cent,  of  all 
homicides.  In  the  general  population  of  the  Registration  Area 
only  14.2  per  cent,  were  accomplished  through  this  means. 

The  homicide  death  rate  in  this  insurance  experience  was  nearly 
7£  times  as  great  for  colored  males  as  for  the  entire  group  of 
insured  wage  earners.  This  rate  (52.2  per  100,000)  was  almost  ten 
times  that  of  white  males  (5.4  per  100,000).  Among  colored 
females  there  was  registered  a  death  rate  for  homicide  of  14.1 
per  100,000  exposed.  This  rate  is  nearly  three  times  that  recorded 
for  white  males  and  over  seven  times  the  rate  for  white  females. 
In  the  following  table  and  in  Chart  XIV,  page  141,  we  give  a  com- 
parison of  the  homicide  death  rates  in  this  insurance  experience 
according  to  color,  sex  and  age  classes: 

TABLE  81. 

MORTALITY  FROM  HOMICIDE  (ALL  FORMS),  CLASSIFIED  BY  COLOR,  Sax  AND 

BY  AGE  PERIOD. 

Death  Rates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persona. 

Wblte. 

Colored. 

Males. 

Females. 

Male*. 

Females. 

All  ages  —  one  and 
over        

7.0 

5.4 

1.9 

52.2 

14.1 

1  to  14.  . 

.7 
5.8 
12.5 
16.0 
11.4 
7.3 
4.6 
2.8 
3.4 

.6 
4.4 
8.5 
11.8 
10.5 
9.4 
7.3 

^ 

.6 
2.1 
3.6 
3.3 
2.8 
1.9 
1.3 
1.1 
1.7 

3.1 
40.6 
95.6 
106.0 
66.6 
40.1 
19.2 
13.4 
41.2 

1.1 
14.1 
30.1 
26.6 
13.4 
6.8 
5.7 
2.3 
18.1 

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  . 

The  age  period  of  maximum  incidence  for  males  in  both  color 
classes  was  the  same — 25  to  34  years.  For  white  and  colored  fe- 
males the  maximum  rate  occurred  at  an  earlier  period,  20  to  24 
years  of  age.  Among  colored  males  this  maximum  rate  was  106 
per  100,000  exposed.  Homicide  among  colored  males  was  one  of 
the  chief  causes  of  death,  ranking  next  to  pneumonia  in  order  of 
numerical  importance  at  this  age  period  in  life.  It  will  be  noted, 


EXTERNAL  CAUSES  OF  DEATH. 


141 


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142 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


however,  that  the  age  period  20  to  24  years  had  only  a  slightly 
lower  homicide  rate,  95.6  per  100,000  exposed. 

Homicide  assumes  alarming  proportions  as  a  cause  of  death 
among  the  colored  population  of  the  United  States.  No  conve- 
nient or  all-inclusive  explanation  of  this  phenomenon  among  col- 
ored persons  can  be  made  in  this  present  discussion.  The  homicide 
problem  is  entirely  too  grave  and  grows  out  of  so  many  other  com- 
plex social  situations  that  we  cannot,  at  the  present  time,  do  more 
than  to  indicate  the  necessity  for  a  further  and  qualified  inquiry 
into  the  problem. 

The  ratio  of  the  homicide  rates  for  white  and  colored  persons, 
according  to  sex,  may  be  pointed  out,  however,  in  passing.  The 
following  table  gives  a  convenient  view  of  the  ratios  of  white  and 
colored  mortality  at  the  several  age  periods  in  each  sex: 

TABLE  82. 

MORTALITY  FROM  HOMICIDE   (ALL  FORMS). 
Percentage,  Colored  of  White  Mortality  at  Specified  Age  Periods  for  Each 


Sex.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company. 
Department. 


Industrial 


Age  Period. 

Percentage.  Colored  of  White  Mortality. 

Males. 

Females. 

All  ages  —  one  and  over.  ...... 

966.7 

742.1 

15  to  19.  . 

922.7 
1124.7 
898.3 
634.3 
426.6 
263.0 
326.8 
—  t 

671.4 
836.1 
806.1 
478.6 
357.9 
438.5 
209.1 
1064.7 

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

fNo  deaths  of  white  males  from  homicide  in  this  age  period. 

It  will  be  seen  that  for  the  entire  experience  the  homicide  rate 
for  colored  males  is  practically  ten  times  that  of  white  males.  At 
the  age  period  20  to  24  years  the  colored  male  homicide  rate  is  more 
than  eleven  times  that  of  the  white  male  rate.  There  is  a  tendency 
toward  decrease  in  this  ratio  with  advancing  age.  At  all  ages,  1 
and  over,  in  this  experience,  colored  females  show  a  homicide  rate 
nearly  7£  times  that  of  white  females.  At  the  age  period  20  to  24 
years  colored  female  homicide  mortality  is  more  than  8$  times  the 


EXTERNAL  CAUSES  OF  DEATH. 


143 


rate  for  white  females.  Between  25  and  34  years,  homicide  among 
colored  females  is  still  more  than  eight  times  as  prevalent  as  among 
white  females. 

We  may  inquire  briefly  also  into  the  sex  ratio  of  homicide  mor- 
tality according  to  age  period  for  each  of  the  color  classes.  The 
facts  available  are  shown  in  the  following  table : 

TABLE  83. 

MORTALITY  FROM  HOMICIDE   (ALL  FORMS). 
Percentage,  Male  of  Female  Mortality  at  Specified  Age  Periods  for  Each 

Color   Class.     1911    to    1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Percentage,  \Iale  of  Female  Mortality. 

White. 

Colored  . 

All  ages  —  one  and  over  

284.2 

370.2 

15  to  19  

209.5 
236.1 
357.6 
375.0 
494.7 
561.5 
372.7 
—  t 

287.9 
317.6 
398.5 
497.0 
589.7 
336.8 
582.6 
227.6 

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

f  No  deaths  of  white  males  from  homicide  in  this  age  period. 

Males  among  white  persons  show  a  homicide  death  rate  nearly 
three  times  that  of  females.  For  the  colored  race,  males  have  a 
homicide  death  rate  nearly  3|  times  that  of  females.  The  excess 
of  the  homicide  rate  for  males  over  the  rate  for  females  increases 
with  age  up  to  the  period  55  to  64  years  among  white  persons  and 
up  to  the  period  45  to  54  years  among  colored  persons. 

Homicide  Rate  Among  Insured  Wage  Earners  and  Among  Popula- 
tion of  the  Expanding  Registration  Area  of  the  United 
States  Compared. 

We  offer  on  page  144  a  comparison  of  the  homicide  death  rates 
among  white  persons  in  the  insurance  experience  and  among  all 
persons  in  the  Registration  Area  experience. 

These  two  groups  are  in  many  respects  comparable.  It  must 
be  remembered,  however,  that  the  statistics  for  the  expanding  Reg- 
istration Area  of  the  United  States  are  affected  by  a  small  propor- 


144 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


tion  of  colored  persons,  about  5  per  cent.  In  view,  however,  of  the 
extraordinarily  high  homicide  rate  among  this  latter  group  of  the 
population,  the  figures  for  the  total  population  as  to  homicide  are, 
undoubtedly,  a  little  higher  than  they  would  be  had  it  been  possible 
to  exclude  this  statistical  group.  Thus,  in  making  this  present 
comparison,  we  must  bear  in  mind  that  about  5  per  cent  of  the 
population  material  is  affected  by  a  homicide  death  rate  between 
seven  and  ten  times  as  high  as  that  of  white  persons.  This  one 
fact  may  be  sufficient  in  itself  to  account  for  the  exceptionally 
favorable  homicide  figures  among  insured  white  males  and  females 
shown  in  the  following  table: 

TABLE  84. 

MORTALITY  FROM  HOMICIDE   (ALL  FORMS). 

Death  Eates  per  lOOflOO  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  i    I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Percentage 
M.  L.  I.  Co. 
of  Reg.  Area. 

All  ages  —  one 
and  over  .... 

5.4 

10.4 

51.9 

1.9 

2.7 

70.4 

1  to  14  

.6 

.9 

66.7 

.6 

7 

85.7 

15  to  19  

4.4 

6.1 

72.1 

2.1 

3.0 

700 

20  to  24  

8.5 

16.9 

50.3 

3.6 

5.0 

720 

25  to  34  

11.8 

19.3 

61.1 

3.3 

4.7 

70.2 

35  to  44  

10.5 

16.6 

63.3 

2.8 

3.5 

80.0 

45  to  54  

9.4 

11.7 

80.3 

1.9 

2.1 

90.5 

55  to  64  

7.3 

8.1 

90.1 

1.3 

1.5 

86.7 

65  to  74  

4.1 

5.7 

71.9 

1.1 

1.2 

91.7 

75  and  over  .  . 

3.7 

1.7 

1.6 

106.3 

For  all  ages  one  and  over  the  homicide  rate  for  insured  white 
males  was  only  52  per  cent,  of  that  among  all  males  in  the  expand- 
ing Registration  Area  of  the  United  States.  Among  insured  white 
females  the  homicide  rate  was  only  70  per  cent,  of  the  rate  prevail- 
ing in  the  Registration  Area  group  of  females.  Beginning  with  the 
age  period  25  to  34  years,  however,  there  is,  with  unimportant  ex- 
ceptions, an  increasing  tendency  toward  equality  in  the  homi- 
cide rates  of  the  two  experiences.  At  the  age  period  55  to  64  years, 


EXTERNAL  CAUSES  OF  DEATH. 


145 


insured  white  males  have  a  homicide  rate  only  10  per  cent,  more 
favorable  than  that  of  males  in  the  population  experience. 

Trend  of  the  Death  Rate  for  Homicide. 

In  the  experience  for  insured  wage  earners  we  observe  a  fluctuating 
rate  from  this  cause,  with  no  distinct  upward  or  downward  tend- 
ency for  any  of  the  color  or  sex  classes,  with  the  possible  exception 
of  colored  males  for  whom  there  was  perhaps  a  tendency  toward 
increase.  The  1916  death  rate  for  homicide,  compared  with  the 
1911  rate,  showed  a  slight  decrease  for  white  males,  a  constant  rate 
for  white  females,  an  increase  of  practically  eight  points  per  100,000 
for  colored  males  and  a  decrease  for  colored  females.  It  will  be 
recalled  that  the  suicide  rate  during  1916  showed  a  tendency  to 
reflect  the  conditions  of  unprecedented  prosperity  which  prevailed 
throughout  the  sections  of  the  country  where  the  Company  does 
business  among  wage  earners.  This  condition  of  generally  better 
economic  status  for  the  industrial  population  of  the  United 
States  apparently  did  not  affect  the  homicide  death  rate,  however, 
probably  because  there  is  no  very  close  connection  between  the 
homicidal  impulse  and  material  well-being.  The  crime  of  homi- 
cide is  precipitated,  perhaps,  in  persons  afflicted  with  various  types 
of  mental  and  nervous  defects  and  diseases,  by  other  than  economic 
stresses  and  circumstances.  In  the  following  table  we  give  a  state- 
ment of  the  trend  of  the  homicide  death  rate  during  the  six  years 
of  this  present  investigation: 

TABLE  85. 

MORTALITY  FROM  HOMICIDE  (ALL  FORMS),  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White.                                       Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

7.0 

5.4 

1.9 

52.2 

14.1 

1916  

6.9 
6.9 
7.0 
7.2 
6.7 
7.2 

5.4 
5.5 
5.5 
4.8 
5.2 
5.9 

2.0 
2.0 
1.9 
2.1 
1.6 
2.0 

54.0 
49.9 
54.0 
57.8 
50.4 
46.2 

14.3 
15.8 
12.6 
13.1 

12.8 
15.9 

1915     

1914  

1913  

1912  

1911  

11 


146          MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 

In  the  experience  of  the  general  population  of  the  Registration 
Area  we  observe,  likewise,  a  practically  stationary  death  rate  from 
the  crime  of  homicide.  It  must  be  remembered,  however,  that 
between  1911  and  1915,  the  period  for  which  population  data  are 
available  at  the  present  writing,  a  number  of  areas  containing  a 
large  number  of  colored  persons  were  added  to  the  registration 
record  and  that  this  fact  in  itself  had  a  tendency  to  slacken  a  slight 
decrease  in  homicide,  if  any  such  really  existed. 


CHAPTER   IX. 

CANCER  (ALL  FORMS). 

Although  there  have  appeared  many  and  important  contributions 
to  the  mortality  statistics  of  cancer  in  recent  years,  none  of  these 
has  presented  the  facts  in  such  detail  as  to  show  the  incidence  of 
this  condition  in  the  several  age  periods  of  life  with  the  further 
distinction  of  sex  and  of  color  or  race  of  the  population.  This  is 
the  merit  of  the  data  presented  herewith.  They  are  to  our  knowl- 
edge original  in  the  cancer  literature  and  should  well  serve  the 
nation-wide  movement  for  the  control  of  the  disease.  Many  dis- 
cussions which  have  centered  around  the  cancer  problem  in  recent 
years,  such  as  the  supposed  increase  of  mortality  and  other  ques- 
tions, can  be  settled  only  as  we  know  for  a  period  of  years  the 
detailed  facts  of  mortality  for  a  relatively  constant  population. 
The  present  experience  meets  this  requirement  admirably  and  has 
the  further  merit  that  it  reflects  conditions  in  a  large  industrial 
group  among  whom,  as  will  be  shown  later,  cancer  takes  a  heavy 
toll. 

Special  efforts  were  made  in  the  course  of  the  present  inquiry  to 
have  the  basic  data  as  reliable  as  possible.  Physicians  certifying 
the  causes  of  death  often  returned  statements  of  cancer  unqualified 
as  to  the  organ  or  part  affected.  In  such  instances,  letters  of  in- 
quiry were  written  and  the  physicians  were  asked  to  specify  the 
type  of  tumor  or  cancer  and  the  organs  or  parts  first  affected  by 
the  growth.  The  effect  of  this  correspondence  has  been  to  increase 
the  precision  of  the  statistical  results  for  cancer.  While  the  data 
were  not  refined  to  the  same  point  of  completeness  as  characterized 
the  recent  investigation  of  the  United  States  Bureau  of  the  Cen- 
sus, the  effort  was  made  to  cover  fully  the  various  parts  and  or- 
gans specified  in  the  International  List  of  Causes  of  Death. 

During  the  six  year  period  of  this  investigation,  37,666  cancer 
deaths  were  recorded  at  a  rate  of  70.0  per  100,000  persons  exposed. 
Cancer  was  the  sixth  cause  in  order  of  numerical  importance  in 
this  study.  These  deaths  constituted  5.9  per  cent,  of  all  the  deaths 

147 


148 


MORTALITY    STATISTICS   OP   INSURED   WAGE   EARNERS. 


in  the  experience.  In  the  following  table,  the  facts  are  arranged 
so  as  to  show  the  number  of  deaths  from  cancer  of  the  various 
organs  or  parts,  and  a  few  derivative  ratios,  including  the  death 
rates  per  100,000  persons  exposed,  are  given: 

TABLE  86. 

MORTALITY  PROM  CANCER,  SPECIFIED  ACCORDING  TO  ORGANS  OR  PARTS 

AFFECTED. 

Deaths,  and  Death  Bates  per  100,000  Persons  Exposed. 
AU  Color  and  Sex  Groups  Combined. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Organ  or  Pan  Affected. 

All  Color  and  Sex  Groups  In  Mortality  Experience. 

No.  of 
Deaths. 

Per  Cent,  of 
Total—  All 

Causes. 

Per  Cent,  of 
Total  Can* 
cer  Deaths. 

Death  Rate 
per  100.000 
Exposed. 

CANCER  —  ALL  FORMS  

37,666 

5.9 

100.0 

70.0 

Cancer  of  the: 
Buccal  cavity  

1,353 
14,153 

4,482 
7,882 
3,579 
938 

5,279 

.2 
2.2 

.7 
1.2 
.6 
.2 

.8 

3.6 
37.6 

11.9 
20.9 
9.5 
2.5 

14.0 

2.5 
26.3 

8.3 
14.7 
6.7 
1.7 

9.8 

Stomach,  liver  

Peritoneum,  intestines, 
rectum  

Female  genital  organs  
Breast    .  .        

Skin       

Other  organs,  or  of  organs 
not  specified  

Cancer  and  other  malignant  tumors  of  the  stomach  and  liver  con- 
stituted the  largest  single  group  of  malignant  growths,  with  37.6 
per  cent,  of  all  cancers,  at  a  rate  of  26.3  per  100,000  persons  ex- 
posed. Cancer  of  the  female  genital  organs  was  next  in  import- 
ance, with  7,882  deaths,  constituting  20.9  per  cent,  of  all  cancer 
deaths  with  a  rate  of  14.7  per  one  hundred  thousand  persons  of 
both  sexes.  Cancers  affecting  the  peritoneum,  intestines  and 
rectum  followed  with  4,482  deaths,  in  all  11.9  per  cent,  of  all 
cancers  at  a  rate  of  8.3  per  100,000.  These  death  rates,  however, 
vary  considerably  with  age  and  sex.  In  the  following  table,  we 
give  a  comparison  of  the  general  cancer  mortality  experience  for 
each  of  the  main  color  and  sex  classes,  showing  separately  the  facts 
for  cancer  of  the  various  organs  or  parts.  The  age  data  will  be 
presented  later. 


CANCER. 


149 


TABLE  87. 
MORTALITY  FROM  CANCER,  CLASSIFIED  ACCORDING  TO  ORGANS  OR  PARTS. 

Percentage  of  Deaths,  all  Causes,  and  Death  Bates  per  100,000  Persons 
Exposed.     By  Color  and  by  Sex.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Organ  or  Part  Affected. 

Total  Ex- 
perience. 

White 
Malea. 

White  Fe- 
males. 

Colored 
Malea. 

Colored  Fe- 
males. 

P.  C.  of 
Deaths  — 
All  Causes. 

Death  Rate 
per 
100.000. 

P.  C.  of 

Deaths  — 
All  Causes. 

Death  Rate 
per 
100,000. 

P.  C.  of 
Deaths  — 
All  Cauaea. 

Death  Rate 
per 
100.000. 

P.  C.  of 

Deaths  — 
All  Causes. 

Death  Rate 
per 
100.000. 

P.  C.  of 

Deaths  — 
All  Cauaea. 

Death  Rate 
per 
100,000. 

CANCER  —  ALL  FORMS.  . 

Cancer  of  the: 
Buccal  cavity  
Stomach,  liver.  .  .  . 
Peritoneum,  intes- 
tines, rectum  .  .  . 
Female  genital 
organs  

5.9 

70.0 

4.3 

50.4 

8.5 

88.4 

1.8 

31.0 

5.2 

87.8 

.2 
2.2 

.7 

1.2 
.6 
.2 

.8 

2.5 
26.3 

8.3 

14.7 
6.7 
1.7 

9.8 

.4 
2.1 

.6 

* 
.2 

1.0 

4.6 

24.8 

6.6 

.1 

2.2 

12.0 

.1 

2.9 
1.0 

2.4 
1.1 

.2 

.8 

.9 

29.8 

10.5 

25.3 
11.7 
1.6 

8.6 

.1 
.9 

.2 

* 
* 

.4 

2.5 
16.2 

3.4 

.3 

.8 

7.9 

.1 
1.1 

.4 

2.2 

.9 

* 

.4 

1.3 

18.5 

7.2 

37.9 
14.7 

.7 

7.3 

Breast  

Skin  

Other  organs  or  of 
organs  not  spec- 
ified   

*  Less  than  .05  per  cent. 

We  see  from  this  table  that  for  all  ages  one  and  over  combined, 
white  persons  show  higher  cancer  death  rates  than  colored  persons, 
although  the  white  female  rate  is  only  slightly  higher  than  that 
for  colored  females.  Various  differences  between  the  cancer  death 
rates  of  the  color  and  sex  classes  occur  for  this  disease  as  it  affects 
various  organs  or  parts.  White  males,  for  instance,  show  uni- 
formly higher  cancer  death  rates  for  each  of  the  organs  or 
parts  than  are  in  evidence  for  colored  males.  White  females 
show  significantly  lower  cancer  death  rates  for  this  disease  only  as 
it  affects  the  female  genital  organs  and  the  breast.  Cancer  of  the 
uterus  and  of  the  other  genital  organs  shows  a  rate  of  25.3  per 
one  hundred  thousand  white  females  exposed  and  a  rate  of  37.9 
for  colored  females.  Cancer  of  the  breast,  in  this  present  mortality 
experience,  was  recorded  at  a  rate  of  11.7  per  one  hundred  thou- 
sand white  females,  and  at  a  rate  of  14.7  per  one  hundred  thou- 
sand colored  females.  For  the  other  chief  organs  or  parts,  cancer 
mortality  of  white  females  is  greater  than  among  colored  females. 


150 


MORTALITY    STATISTICS  OF  INSURED   WAGE  EARNERS. 


In  a  later  part  of  this  present  section,  we  shall  bring  out  in  greater 
detail  the  age  characteristics  of  this  cancer  mortality  experience 
for  the  several  color  and  sex  classes,  and  with  distinction  of  the 
several  organs  and  parts.  We  quote  below  our  general  cancer  death 
rates  per  one  hundred  thousand  persons  exposed  in  each  of  the 
color  and  sex  classes  for  the  various  age  periods.  Chart  XV 
shows  the  course  of  the  cancer  death  rates  in  the  experience  ac- 
cording to  age,  for  each  of  the  color  and  sex  classes. 

TABLE  88. 

MORTALITY  FROM  CANCER,  ALL  FORMS,  CLASSIFIED  BY  COLOR,  SEX  AJJD  BY 

AGE  PERIOD. 

Death  Kates  per   100,000  Persons   Exposed,     1911   to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

70.0 

50.4 

88.4 

31.0 

87.8 

1  to  4  

3.7 
1.4 
1.3 
2.8 
4.1 
15.7 
76.2 
198.6 
382.5 
617.2 
818.2 

3.7 

1.5 
1.5 
2.8 
4.6 
8.8 
38.3 
147.0 
356.2 
625.3 
822.8 

4.0 
1.6 
1.4 
2.8 
3.7 
18.5 
99.3 
238.6 
423.2 
665.1 
863.9 

2.6 
1.0 
.3 
2.2 
1.3 
7.5 
30.0 
84.7 
183.1 
230.5 
384.1 

2.5 
1.0 
.6 
2.9 
6.3 
33.2 
118.1 
238.7 
359.1 
433.4 
580.7 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.. 

In  the  introduction  to  this  present  section,  we  indicated  that,  in 
general,  cancer  mortality  was  lower  among  colored  persons  than 
among  white  persons,  and  that  colored  males  showed  relatively 
more  favorable  rates  than  colored  females.  Without  any  emphasis 
at  this  present  time  upon  the  organs  or  parts  affected  by  cancer, 
we  may  now  consider  the  general  age  characteristics  of  this  disease. 

A  fairly  significant  rate  is  registered  for  the  ages  one  to  four 
years  in  the  total  experience.  The  cancer  rate  declines  thereafter 
to  its  minimum  at  ten  to  fourteen  years  of  age  and  then  rises,  at 
first  gradually,  but  afterward  in  heavy  increments  up  to  the  latest 
age  period  in  this  series.  The  same  general  characteristics  of  the 


CANCEE. 


151 


152          MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

age  course  of  cancer  mortality  arc  observed  for  white  males  as  for 
white  females,  with  the  exception  that  the  upward  slope  of  the  curve 
for  white  females  is  very  much  sharper  for  the  ages  beyond  25 
years.  The  cancer  death  rates  for  colored  persons  under  25  years 
of  age  are,  for  the  most  part,  very  low,  and  fluctuate  somewhat 
irregularly.  Beginning  with  the  age  period  25  to  34  years,  how- 
ever, there  is  a  constantly  increasing  rate,  up  to  the  highest  age 
period  recorded  in  this  series. 

Color  Ratio  of  Cancer  Mortality. 

White  males  show  emphatically  higher  cancer  death  rates  at 
every  age  period  than  were  recorded  for  colored  males.  Compari- 
sons between  the  cancer  death  rates  of  white  and  colored  females 
are  practicable  beginning  with  the  age  period  25  to  34  years.  Be- 
tween 25  and  44  years,  the  cancer  death  rate  of  white  females 
was  decidedly  lower  than  the  rate  for  colored  females.  Between 
45  and  54  years,  the  rates  were  practically  the  same.  Beginning 
with  the  age  period  55  to  64  years  and  continuing  to  the  highest 
age  period  in  the  table,  we  observe  that  the  cancer  death  rates  of 
white  females  were  much  higher  than  the  rates  for  colored  female?. 
These  differences  in  the  total  cancer  death  rates  of  white  and 
colored  females  are  to  be  accounted  for,  as  will  be  shown  later,  by 
the  higher  mortality  from  cancer  of  the  generative  organs  among 
colored  females. 

Sex  Ratio  of  Cancer  Mortality. 

We  have  seen  that  among  white  lives  the  cancer  death  rate  of 
females  was  practically  one  and  two-thirds  that  of  males. 
Cancer  mortality  of  white  males  exceeds  that  of  white  females  only 
for  cancer  of  the  buccal  cavity,  where  the  rates  are  4.6  and  .9  per 
100,000  persons  exposed,  respectively;  for  cancer  of  the  skin, 
where  the  rates  are  2.2  and  1.6  respectively,  and  for  the  group  of 
"cancers  of  other  organs  or  of  organs  not  specified."  For 
cancer  of  the  stomach  and  liver  and  of  the  peritoneum,  intestines 
and  rectum,  the  death  rates  of  white  females  were  decidedly  in 
excess  of  those  for  white  males.  In  addition,  white  females  showed 
a  high  death  rate  for  cancer  of  the  female  genital  organs  (25.3  per 
one  hundred  thousand)  and  for  cancer  of  the  breast  (11.7  per  one 
hundred  thousand).  Practically  the  same  general  remarks  apply 


CANCER. 


153 


to  the  comparative  cancer  death  rates  of  colored  males  and  colored 
females  when  compared  with  respect  to  the  several  organs  affected 
by  malignant  growths. 

There  are  no  important  differences  in  the  cancer  mortality  of  the 
two  s«xes  among  white  lives  under  25  years  of  age.  Beginning  with 
the  age  period  25  to  34  years, .  however,  the  cancer  death  rates  of 
white  females  exceed  those  of  white  males  substantially,  up  to  and 
including  the  age  period  55  to  64  years.  Thus  at  the  age  period  35 
to  44  years  the  rate  for  white  males  was  only  38.6  per  cent,  of  that 
for  white  females.  After  age  65,  the  disproportion  between  the 
rates  for  the  two  sexes  among  white  lives  is  not  so  great. 

The  excess  of  the  cancer  death  rate  of  colored  females  over  the 
rate  for  colored  males  is  much  greater  than  was  observed,  age 
period  by  age  period,  for  white  lives.  Thus  between  25  and  45, 
the  rate  for  colored  males  was  only  about  one-fourth  as  great  as 
for  colored  females.  In  the  following  table,  we  give,  first,  a 
statement  of  the  ratio  of  cancer  mortality  between  the  two  races 
and,  second,  the  sex  ratio  according  to  age  period : 

TABLE  89. 

MORTALITY  FROM  CANCER  (ALL  FORMS). 
Percentages:  Colored  of  White  Mortality  by  Sex;  Male  of  Female  Mortality 

by  Color;  Classified  by  Age  Period.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Per  Cent.  Colored  of  White 
Mortality. 

Per  Cent.  Male  of  Female 
Mortality. 

Males. 

Females. 

White. 

Colored. 

ALL  AGES  —  ONE  AND 
OVER  

61.5 

99.3 

57.0 

35.3 

1  to  4  

70.3 
66.7 
20.0 
78.6 
28.3 

43.0 

62.5 
62.5 
42.9 
103.6 
170.3 

80.1 

92.5 
93.8 
107.1 
100.0 
124.3 

70.5 

37.9 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

AGES  25  AND  OVER  
25  to  34  

85.2 
78.3 
57.6 
51.4 
36.9 
46.7 

179.5 
118.9 
100.0 
84.9 
65.2 
67.2 

47.6 
38.6 
61.6 

84.2 
94.2 
95.2 

22.6 
25.4 
35.5 
51.0 
53.2 
66.1 

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  

Insufficient  data. 


154          MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


Comparison  of  Cancer  Death  Rates  among  Insured  Wage  Earners 

with  Rates  for  Population  of  Expanding  Registration  Area 

of  the  United  States. 

For  both  males  and  females,  at  all  ages  one  and  over  combined, 
the  cancer  death  rates  of  white  lives  in  the  insurance  experience  are 
substantially  lower  than  the  rates  recorded  in  the  Registration  Area 
of  the  United  States.  This  favorable  ratio  for  the  cancer  mortality 
experience  of  insured  wage  earners  does  not  hold  for  all  of  the 
age  periods.  Thus,  the  cancer  death  rate  among  white  male  wage 
earners  is,  in  general,  lower  than  the  rate  for  males  in  the  general 
population  only  at  ages  under  35  years.  Among  white  insured 
females,  the  cancer  death  rate  is  lower  than  the  rate  among  females 
in  the  general  population  only  between  20  and  35  years  of  age. 

The  cancer  death  rate  among  both  white  males  and  white  females 
of  the  insurance  experience  is  higher  than  the  rate  for  males  and 
females  in  the  Registration  Area  at  every  age  period  beyond  35 
years  of  age,  where  cancer  is  of  the  most  importance  as  a  cause  of 
death.  It  should  be  remarked  also  that  male  wage  earners  show 
much  greater  percentages  of  excess  in  cancer  mortality  than  do 
females  in  wage  earners'  families.  The  following  table  sets  forth 
these  comparative  facts  of  cancer  mortality: 

TABLE  90. 

MORTALITY  FROM  CANCER  (ALL  FORMS). 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

XT.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

TJ.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg  .Area. 

(White). 

Area. 

of  Reg.  Are*. 

All  aees  —  one 

and  over  

50.4 

62.2 

81.0 

88.4 

97.9 

90.3 

Ito4... 

3.7 

3.6 

102.8 

4.0 

3.1 

129.0 

5to9... 

1.5 

2.0 

75.0 

1.6 

1.4 

114.3 

10  to  14.  . 

1.5 

1.7 

88.2 

1.4 

1.4 

100.0 

15  to  19.. 

2.8 

2.9 

96.6 

2.8 

2.6 

107.7 

20  to  24.. 

4.6 

4.4 

104.5 

3.7 

4.6 

80.4 

25  to  34.. 

8.8 

9.3 

94.6 

18.5 

20.8 

88.9 

35  to  44.. 

38.3 

31.9 

120.1 

99.3 

89.0 

111.6 

45  to  54.. 

147.0 

109.8 

133.9 

238.6 

227.0 

105.1 

55  to  64.. 

356.2 

280.3 

127.1 

423.2 

406.9 

104.0 

65  to  74.. 

625.3 

503.4 

124.2 

665.1 

607.0 

109.6 

75  and  over 

822.8 

710.2 

115.9 

863.9 

828.2 

104.3 

CANCER. 


155 


Relation  of  Cancer  to  Economic  Condition  or  Social  Status. 

At  this  point  in  the  discussion,  brief  reference  may  be  made  to 
the  possible  relation  between  the  incidence  of  cancer  mortality  and 
economic  status,  as  indicated  in  a  paper  recently  published  on  this 
subject.*  The  following  table  shows  the  main  facts  of  an  in- 
vestigation based  upon  the  comparative  mortality  experience  of  the 
Ordinary,  Intermediate  and  Industrial  Departments  of  the  Metro- 
politan Life  Insurance  Company  during  the  three  years  1914,  1915, 
and  1916.  White  lives  only  were  included  in  this  investigation. 
The  Ordinary  Department  policyholders  are  drawn  from  higher 
economic  strata  of  the  population  than  are  the  "Intermediate" 
group.  The  Industrial  policyholders  form  the  third  class  or  group 
in  order  of  material  circumstance.  In  order  to  eliminate  the 
slight  effect  of  medical  selection  in  the  Ordinary  and  Intermedi- 
ate groups  with  respect  to  cancer,  we  considered  only  the  mortal- 
ity in  these  classes  on  business  in  force  at  least  five  years. 

TABLE  91. 
CANCER  CLAIM  BATES  PER  HUNDRED  THOUSAND  MEAN  IN  FORCE. 

Ordinary  and  Intermediate  Departments,  First  Five  Years  of  Issue  Excluded 

Compared  with  Industrial  Department,  All  Years  of  Issue  Combined. 

Composite  Mortality  Experience  1914,  1915,  and  1916.     White 

Lives.    By  Sex  and  ~by  Age  Period. 


Sex  and  Age  Period. 

Ordinary  De- 
partment. 

Intermediate 
Branch. 

Industrial  De- 
partment, 

MALES: 
Ages  25  and  over  

83.5 

70.3 

140.0 

25  to  34  

12.0 

8.7 

9.7 

35  to  44  

33.4 

41.8 

37.5 

45  to  54  

104.3 

107.6 

154.1 

55  to  64  

276.5 

295.1 

368.0 

65  and  over  

662.5 

645.3 

679.2 

FEMALES  : 
Ages  25  and  over  

141.6 

115.1 

197.7 

25  to  34  

31.4 

25.4 

17.8 

35  to  44  

71.6 

87.8 

98.9 

45  to  54  

213.5 

206.7 

235.8 

55  to  64  

353.6 

422.1 

429.6 

65  and  over  

313.1 

1,009.8 

707.5 

*  Knight,  Augustus  S.,  and  Dublin,  Louis  I.,  ' '  The  Eelation  of  Cancer 
to  Economic  Condition. ' '  Bead  before  the  ASSOCIATION  OF  LIFE  INSURANCE 
MEDICAL  DIRECTORS  OF  AMERICA,  Worcester,  Mass.,  October  17,  1917.  Ee- 
printed  by  Metropolitan  Life  Insurance  Company,  New  York,  1917. 


156         MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

In  this  table,  claim  rates  per  one  hundred  thousand  mean  in-force 
for  the  several  departments  are  compared.  Actual  experience 
demonstrates  that  very  little  error  is  involved  in  a  comparison  of 
mortality  rates  based  upon  the  number  of  claims  reported  and  the 
mean  number  of  policies  in-force  if  such  data  are  related  strictly 
to  age  periods.  The  comparison  is  valid  therefore  as  above  given. 
Because  of  the  heavy  representation  of  policyholders  at  the  ages 
under  45  years,  with  a  small  number  -of  deaths,  leading  to  aberrant 
cancer  death  rates  for  these  ages,  the  Intermediate  rates  for  both 
males  and  females  at  all  ages  are  apparently  the  lowest.  At  the 
ages  beyond  45  years,  where-  cancer  mortality  is  numerically  signi- 
ficant, the  Industrial  group  showed  the  highest  rate,  the  Ordinary 
the  least  and  the  Intermediate  a  rate  between  the  other  two.  As  a 
result  of  an  extended  consideration  of  the  data  developed  in  this 
inquiry  into  the  possible  relation  of  cancer  and  economic  condition, 
it  was  concluded  that: 

1.  The  current  medical  opinion  that  there  is  strong  association 

between  low  economic  status  and  a  low  cancer  death  rate  is 
in  all  probability  unfounded. 

2.  The  cancer  mortality  rate  at  the  ages  where  the  cancer  rate  is 

significant,  decreases  as  we  go  up  in  the  economic  scale. 

3.  This  is  shown  to  be  true  for  each  sex  where  sufficient  data  are 

available. 

4.  This  conclusion  is  not  conditioned  by  the  effect  of  varying 

amounts  of  medical  selection  in  the  three  groups  considered. 

Trend  of  the  Cancer  Death  Rate. 

Medical  literature  of  the  past  few  years  contains  much  contro- 
versy on  the  question  whether  mortality  from  cancer  is  actually 
increasing  or  not.  One  school  of  research  holds  "that  the  mor- 
tality from  cancer  is  increasing  at  a  more  or  less  alarming  rate 
throughout  the  entire  civilized  world  and  that  this  increase  implies 
most  serious  consequences,  present  and  future,  to  the  populations 
concerned."*  Another  group  of  statisticians  holds  that  "the  re- 
ported mortality  from  cancer  is  increasing  in  almost  every  part  of 
the  world,  but  the  real  mortality,  if  increasing  at  all,  is  certainly 
not  increasing  with  equal  rapidity.  .  .  .  The  cumulative  evidence 

*  Hoffman,  Frederick  L.,  ' '  The  Mortality  from  Cancer  Throughout  the 
World,"  p.  218.  Prudential  Press,  Newark,  New  Jersey,  1915. 


CANCER. 


157 


that  improvements  in  diagnosis  and  changes  in  age  composition 
explain  away  more  than  half  and  perhaps  all  of  the  apparent  in- 
crease in  cancer  mortality  rebuts  the  presumption  raised  by  the 
figures  and  makes  it  probable,  though  far  from  certain,  that  cancer 
mortality  is  not  increasing."! 

It  is  not  the  purpose  of  this  bection  to  take  sides  in  the  contro- 
versy. It  is  desired  to  offer  the  mortality  records  of  the  present 
investigation  only  as  a  contribution  to  the  available  supply  of 
trustworthy  data  on  the  trend  of  cancer  mortality.  The  following 
table  shows  the  rates  per  100,000  persons  exposed  in  each  of  the 
color  and  sex  classes  within  the  scope  of  this  inquiry  for  the  years 
1911  to  1916: 

TABLE  92. 

MORTALITY  FROM  CANCER,  ALL  FORMS,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.  Single  Tears  in  Period  1911 

to  1916. 


Experience  of  Metropolitan  Life  Insurance  Company. 
Department. 


Industrial 


Year. 

Persons. 

White. 

Colored. 

Males. 

1  Females. 

Males. 

Females. 

1911  to  1916  

70.0 

50.4 

88.4 

31.0 

87.8 

1916  

70.3 
70.9 
69.8 
70.5 
70.3 
68.0 

51.8 
50.7 
50.7 
51.4 
47.8 
49.6 

87.2 
89.8 
87.9 
87.5 
91.7 
86.5 

36.5 
29.0 
28.0 
32.4 
30.7 
28.9 

86.1 
90.4 
88.3 
93.6 
86.3 
81.3 

1915    

1914    

1913     

1912  

1911  

Cancer  death  rates  in  this  present  experience,  covering  six 
calendar  years,  and  relating  in  all  to  fifty  million  years  of  life  ex- 
posed to  risk,  show  no  decisive  upward  or  downward  tendency  for 
all  age  classes  combined.  This  is  true  for  each  color  and  sex  group, 
but  more  decisively  for  the  group  of  insured  white  females  for 
whom  the  highest  rates  are  recorded.  The  rates,  by  color  and  by 
sex,  for  the  year  1911  are,  to  be  sure,  slightly  lower  than  the  fig- 
ures for  the  entire  six  year  period;  this  condition  may  be  acci- 
dental and  without  significance.  Considering  all  ages  combined, 
therefore,  there  is  no  evidence  presented  in  these  figures  from 

t  Willcox,  Walter  F.,  "On  the  Alleged  Increase  of  Cancer, ' '  Quarterly 
Publications  of  the  American  Statistical  Association,  Sept.,  1917,  p.  756. 


158          MORTALITY   STATISTICS  OF   INSURED   WAGE  EARNERS. 


which    an    increasing    mortality    may    be    predicated    with    any 
certainty. 

It  would  be  more  significant  perhaps  in  this  discussion  to  con- 
sider the  trend  of  the  cancer  death  rate  during  the  six  year  period 
in  a  definite  age  period,  especially  one  in  which  the  cancer  death 
rate  is  usually  high.  For  this  purpose  we  have  chosen  the  age 
period  55  to  64  years.  The  following  table  shows  for  each  one  of 
the  color  and  sex  groups,  the  death  rates  from  cancer  (all  forms) 
during  the  six  year  period: 

TABLE  93. 

MORTALITY  FROM  CANCER  (ALL  FORMS)  AGES  55  TO  64  YEARS,  CLASSIFIED 

BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persona. 

Whlte. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1916.. 

386.4 
380.8 
390.9 
384.1 
381.9 
36-8.7 

358.0 

336.0 
385.0 
370.3 
334.1 
353.3 

427.4 
427.8 
423.3 
414.6 
443.2 
400.2 

218.3 
175.7 
167.7 
195.2 
176.4 
158.0 

339.9 
394.3 
351.7 
368.3 
325.4 
373.7 

1915  

1914  

1913  

1912  

1911  

This  table  shows  very  much  the  same  trend  situation  in  the  age 
period  55  to  64  years  as  we  found  for  all  ages  combined.  The  year 
1911  was  again  a  year  of  comparatively  low  cancer  mortality.  As 
the  figures  are  compared  for  the  individual  years  we  find  some 
variation  with  no  clearly  defined  tendency  toward  increase  or  de- 
crease. Our  data,  therefore,  need  not  serve  to  confirm  either  one 
of  the  two  opposing  opinions  and,  in  fact,  point  out  the  necessity 
for  reserve  and  caution  in  predicating  any  decisive  opinion  with 
regard  to  the  real  trend  of  cancer  mortality  during  recent  years.  A 
longer  period  of  time  will  be  required  to  collect  authentic  figures 
upon  which  a  definite  judgment  can  be  based.  Considerable 
analysis  of  cancer  data  according  to  age,  sex,  color  and  organ  or 
part  affected  will  be  necessary  before  any  final  conclusions  can  be 
drawn  as  to  the  amount  of  increase,  if  any,  in  recent  years.  An- 


CANCER. 


159 


other  view  of  our  data  with  respect  to  this  question  of  cancer 
mortality  increase  is  presented  in  the  following  table: 

TABLE  94. 

MORTALITY  FROM  CANCER  (ALL  FORMS). 

Percentage,  Death  Bate  per  100,000  Persons  Exposed  in  1915-1916  of  Death 
Sate  in  1911-1918.    Classified  by  Color,  Sex  and  by 

Significant  Age  Periods. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

Ages  25  and  over  .  . 
25  to  34  

101.0 

105.2 

98.3 

105.1 

100.7 

98.1 
100.1 
99.1 
102.2 
107.0 
101.0 

121.0 
104.3 
109.7 
101.1 
115.9 
104.1 

94.1 
96.9 
97.0 
101.2 
101.9 
104.4 

95.5 
142.6 
67.7 
118.0 
117.2 
110.7 

95.0 
98.2 
93.1 
105.2 
107.0 
48.6 

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

We  have  eliminated  in  this  table  any  superfluous  references  to 
ages  under  25  years  and  in  order  to  get  at  the  heart  of  the  matter 
have  presented  only  the  percentage  which  the  cancer  death  rate  in 
two  years  combined,  1915-1916,  was  of  the  death  rate  in  two 
prior  years,  1911-1912,  at  each  significant  age  period,  for  each 
color  and  sex  class. 

Considering  all  persons  in  this  mortality  experience  at  ages  25 
and  over,  there  was  an  increase  of  only  1.0  per  cent,  in  the  cancer 
death  rate  between  the  two  periods  compared.  This  figure  is  a 
composite  of  a  variously  weighted  increase  of  5.2  per  cent,  for  white 
males,  a  decrease  of  1.7  per  cent,  for  white  females,  an  increase  of 
5.1  per  cent,  for  colored  males  and  a  practically  stationary  rate  for 
colored  females.  Considered  according  to  age  period,  this  in- 
crease of  1.0  per  cent,  in  the  cancer  death  rate  of  all  persons  in 
this  experience,  aged  25  years  and  over,  was  a  composite  of  a  de- 
crease of  1.9  per  cent,  between  25  and  34  years,  contributed  very 
largely  out  of  the  experience  of  white  and  colored  females,  a  prac- 
tically stationary  death  rate  between  35  and  44  years,  which  is,  in 
itself,  a  composite  of  an  increase  for  white  and  colored  males  and 
a  decrease  for  white  and  colored  females,  and  a  slight  decrease 
between  45  and  54  years.  At  this  latter  age  period,  we  observe  an 


160          MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

increase  of  nearly  ten  per  cent,  in  the  white  male  rate,  a  decrease 
of  3.0  per  cent,  for  white  females,  of  6.9  for  colored  females,  and 
of  32.3  per  cent,  for  colored  males.  The  major  influence,  however, 
in  slightly  lowering  the  cancer  death  rate  of  all  persons  between 
45  and  54  years  was,  of  course,  the  experience  of  the  group  of 
white  females.  Between  55  and  64  years,  all  classes  in  the  mor- 
tality experience  show  an  increase  in  the  rate,  highest  for  colored 
males  and  least  for  white  males.  The  age  period  65  to  74  years 
shows  an  increase  of  7.0  per  cent,  which  is  contributed  very  largely 
by  the  experience  on  male  lives  of  each  color  group.  It  should 
be  remarked  that  the  cancer  experience  of  colored  persons  exert* 
but  slight  influnce  upon  the  ratio  of  increase  of  cancer  mortality 
in  the  entire  experience.  In  fact,  for  some  of  the  age  periods,  the 
data  on  the  increase  of  cancer  mortality  among  colored  persons  are 
aberrant. 

It  will  be  seen  from  the  foregoing  table  that  considerable  analysis 
of  cancer  facts  according  to  age,  sex,  color  and  by  organ  or  part 
affected  is  necessary  before  any  final  conclusions  are  drawn  as  to 
the  amount  of  real  increase  in  cancer  mortality,  if  any,  in  recent 
years.  A  discussion,  in  some  detail,  of  the  cancer  mortality  ex- 
perience according  to  the  organs  or  parts  follows. 

CANCER*  OF  THE  STOMACH  AND  LIVEB, 

The  deaths  classified  under  this  heading  constituted,  as  was 
shown  above,  the  most  important  subordinate  group  of  specific 
types  of  cancer.  Cancers  of  the  stomach  and  liver  were  recorded  in 
37.6  per  cent,  of  all  cancers  in  this  entire  experience.  It  should 
be  remembered  that  this  heading  also  includes  cancers  and  other 
malignant  tumors  of  the  pharynx,  the  esophagus,  and  the  gall 
bladder.f  The  combined  total  of  malignant  growths  of  the  pharynx 
and  esophagus,  however,  numbers  less  than  five  per  cent,  of  all 
deaths  recorded  under  this  heading  in  general  practice,  and  does 
not,  therefore,  seriously  affect  the  present  data.  In  gall  bladder 
cancers  the  liver  is  frequently  involved. 

We  recorded  14,153  deaths  from  malignant  growths  of  the 
stomach  and  liver.  The  death  rate  was  26.3  per  100,000  persons 

*  Cancer  and  other  malignant  tumors. 

t  The  International  list  heading  ' '  Cancer  of  the  Stomach,  Liver, ' '  is 
somewhat  misleading,  inasmuch  as  cancers  of  certain  other  organs  of  the 
digestive  system  are  classified  under  it,  as  noted  above. 


CANCEE. 


161 


exposed.     As  shown  in  the  following  table,  the  facts  vary  con- 
siderably according  to  color,  sex  and  age  period. 

TABLE  95. 

MORTALITY  FROM  CANCER  OF  THE  STOMACH  AND  LIVER,  CLASSIFIED  BY  COLOR, 
SEX  AND  BY  AGE  PERIOD. 

Death   Bates  per   100,000   Persons   Exposed.     1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

26.3 

24.8 

29.8 

16.2 

18.5 

1  to  24  

.3 

3.0 
18.6 
67.2 
168.5 
276.0 
334.7 

.3 

2.9 
18.1 
77.0 
193.3 
303.6 
339.1 

.3 
2.7 
20.1 
67.7 
168.4 
288.7 
353.3 

.2 
3.3 
13.8 
44.0 
108.0 
125.3 
164.6 

.6 
5.0 
16.5 
44.8 
99.5 
122.1 
217.8 

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

There  is  a  higher  death  rate  for  this  cause,  without  important 
exception,  for  white  lives  than  for  colored  lives.  Below  35 
years,  mortality  from  cancer  of  the  stomach  and  liver  is  not  numer- 
ically important.  The  death  rate  increases  from  a  figure  of  18.6 
in  the  age  period  35  to  44  years  to  the  maximum  in  the  highest 
age  period  in  this  series,  75  years  and  over.  Prom  45  years  of 
age  and  onward,  however,  the  death  rate  of  white  males  for  this 
disease  is  appreciably  higher  than  the  rate  for  white  females,  with 
the  exception  of  the  very  highest  age  period,  75  years  and  over. 
Among  colored  persons  the  death  rate  from  cancer  of  the  stomach 
and  liver  is  higher  for  males  than  for  females  between  55  and  74 
years  only.  At  the  ages  under  55  years,  colored  females  show 
higher  death  rates  from  this  cause  than  do  colored  males. 

Comparison  of  Data  for  Cancer  of  the  Stomach  and  Liver  among 

Insured  Wage  Earners  and  among  the  Population  of  the 

Expanding  Registration  Area  of  the  United  States. 

For  both  males  and  females  at  the  ages  where  death  rates  from 
this  cause  are  at  all  significant,  a  higher  death  rate  is  recorded 

12 


162 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


among  the  group  of  insured  wage  earners  than  is  observed  in  the 
Registration  Area  of  the  United  States.  Beginning  with  the  age 
period  35  to  44  years,  there  is  an  excess  of  over  nineteen  per  cent., 
between  45  and  54  years,  an  excess  of  thirty-two  per  cent.,  and 
between  55  and  64  years,  an  excess  of  twenty-nine  per  cent,  over 
the  rates  for  males  prevailing  in  the  expanding  Registration  Area 
of  the  United  States.  The  excess  in  the  death  rate  of  cancer  of 
the  stomach  among  insured  females  is  not  so  great  as  in  the  case 
of  insured  males.  In  the  following  table,  a  comparison  of  the 
foregoing  facts  is  given: 


TABLE  96. 
MORTALITY  PROM  CANCER  OF  THE  STOMACH  AND  LIVER, 

Death  Sates  .per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.     Insured  White  Lives  in  Experience  of  Metropolitan  Life 
Insurance   Company,   Industrial   Department    (1911   to   1916) 
and  General  Population  Experience  of  Expanding  Regis- 
tration Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

M.L.I.  Co. 

(White). 

JU.  S.  Reg. 
Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

All  ages  —  one 
and  over  

24.8 

30.5 

81.3 

29.8 

32.1 

92.8 

Under  25.  . 
25  and  over 

.3 

65.8 

.4 

56.4 

75.0 
116.7 

.3 

63.0 

.3 

61.4 

100.0 
102.6 

25  to  34. 
35  to  44. 
45  to  54. 
55  to  64. 
65  to  74. 
75  and  over 

2.9 
18.1 
77.0 
193.3 
303.6 
339.1 

3.0 
15.2 
58.4 
150.2 
254.3 
294.1 

96.7 
119.1 
131.8 
128.7 
119.4 
115.3 

2.7 
20.1 
67.7 
168.4 
288.7 
353.3 

3.9 
18.2 
62.1 
147.5 
253.6 
313.7 

69.2 
110.4 
109.0 
114.2 
113.8 
112.6 

Trend  of  the  Death  Rate  from  Cancer  of  the  Stomach  and  Liver. 

Not  much  stress  can  be  put  on  the  figures  showing  the  trend  of 
the  death  rate  in  the  period  between  1911  and  1916.  In  the  first 
place,  the  figures  vary  considerably  from  year  to  year,  sometimes 
increasing,  sometimes  decreasing;  also,  cancer  of  the  stomach  and 
liver  affects  organs  which  are  practically  inaccessible  for  purposes 
of  precise  diagnosis.  There  must,  therefore,  be  considerable  uncer- 


DANCER. 


163 


tainty  in  the  degree  of  precision  of  the  diagnosis.  It  will  be  neces- 
sary, therefore,  to  wait  for  an  extension  in  the  period  of  observa- 
tion before  any  definite  tendency  of  the  death  rate  from  this  form 
of  cancer  can  be  predicated.  In  the  meanwhile  as  diagnostic  facili- 
ties become  more  generally  available  and  as  the  practice  of  making 
autopsies  'becomes  more  widespread  it  may  be  expected  that  the 
recorded  death  rates  for  cancer  of  the  stomach  and  liver  will  show 
slight  increases. 

CANCER*  OF  THE  FEMALE  GENITAL  ORGANS. 

Cancer  of  the  female  genital  organs  accounted  for  28.6  per  cent, 
of  all  cancer  deaths  among  white  females.  The  very  largest  pro- 
portion of  these  cancers  affected  the  uterus,  with  the  ovaries  and 
Fallopian  tubes  next  in  numerical  importance. 

TABLE  97. 

MORTALITY  FROM  CANCER  OF  THE  FEMALE  GENITAL  ORGANS,  CLASSIFIED  BY 
COLOR  AND  BY  AGE  PERIOD. 

Death  Rates  per   100,000  Persons  Exposed.    1911   to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 
Department. 


Age  Period. 

White  Females. 

Colored  Females. 

All  ages  —  one  and  over  

25.3 

37.9 

1  to  19  .  . 

.2 

.2 

20  to  24  

1.0 

1.3 

25  to  34  

7.9 

17.7 

35  to  44  

43.4 

62.9 

45  to  54  

85.7 

1097 

55  to  64  

109.4 

131.6 

65  to  74  

110.3 

131  5 

75  and  over  

93.8 

145.2 

In  all,  7,882  deaths  from  cancer  of  the  female  genital  organs 
were  recorded  in  the  six  year  period  of  this  study.  The  rate  has 
significance  only  when  the  deaths  are  related  to  the  number  of 
females  exposed.  The  6,499  cancers  registered  among  white 
females  corresponded  to  a  rate  of  25.3  per  100,000  such  females 
exposed-  and  the  1,383  deaths  among  colored  females  to  a  rate  of 
37.9  per  100,000  exposed.  Under  the  age  of  25  years,  there  was 

*  Cancer  and  other  malignant  tumors. 


164 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


no  significant  mortality  from  this  cause.  Beginning  with  the  age 
period  25  to  34  years,  however,  there  was  a  quite  considerable  rate 
of  mortality,  7.9  per  100,000  for  white  females  and  17.7  for  colored 
females.  This  excess  in  the  mortality  rate  from  cancer  of  the 
female  genital  organs  among  colored  females  is  decidedly  marked 
at  all  of  the  age  periods  in  this  series.  The  maximum  rates  of 
mortality  from  this  cause  appear  at  the  older  ages.  The  foregoing 
table  gives  the  facts  according  to  age  classes  among  white  and 
colored  females. 

Comparison  of  Death  Rates  from  Cancer  of  the  Female  Genital 

Organs  in  Insurance  Experience  on  White  Lives  and  in 

Experience  of  the  Population  of  the  Expanding 

Registration  Area. 

It  is  found  that  white  females  in  wage  earners'  families  show 
a  decided  excess  in  the  mortality  rate  from  cancer  of  the  female 
genital  organs  over  the  rates  recorded  for  females  in  the  general 
population  of  the  expanding  Registration  Area.  The  following 
table  gives  a  comparative  view  of  these  death  rates: 


TABLE  98. 
MORTALITY  FROM  CANCER  OF  THE  FEMALE  GENITAL  ORGANS. 

Death  Eates  per  100,000  Persons  Exposed.     Classified  by  Age  Period.    In- 
sured White  Females  in  Experience  of  Metropolitan  Life  Insurance 
Company,  Industrial  Department  (1911  to  1916)  and  Females 
in  General  Population  Experience  of  Expanding  Regis- 
tration Area  of  the  United  States  (1910  to  1915). 


Females. 

Age  Period. 

M.  L.  I.  Co. 

(White). 

U.  &  Reg.  Area. 

Per  Cent.  M.L. 
I.  Co.  of  Regis- 
tration Area. 

All  ages  —  one  and  over  

25.3 

25.0 

101.2 

Under  25      

.4 

5 

800 

25  and  over  

53.2 

477 

111.5 

25  to  34    

7.9 

84 

940 

35  to  44    

434 

347 

125  1 

45  to  54      

857 

756 

1134 

55  to  64          

1094 

999 

1095 

65  to  74  

110.3 

1032 

106.9 

75  and  over  

93.8 

98.3 

95.4 

CANCEE.  165 

The  greatest  excess  in  mortality  from  cancer  of  the  female 
genital  organs  among  white  females  in  the  families  of  insured  wage 
earners  was  recorded  between  35  and  44  years.  The  percentage 
of  excess  in  mortality  from  this  cause  among  white  females  de- 
creases with  advancing  age,  and  at  the  very  late  ages  in  life  the 
rates  for  both  the  insurance  and  population  experience  tend  to 
approximate  each  other. 

Trend  of  the  Death  Rate  from  Cancer  of  the  Female  Genital 

Organs. 

The  figures  available  show  neither  a  favorable  nor  unfavorable 
tendency  of  the  death  rate  from  cancer  of  the  female  genital  organs. 
There  are  slight  variations  from  year  to  year. 

CANCER*  OF  THE  BREAST. 

TABLE  99. 
MORTALITY  FROM  CANCER  OF  THE  BREAST. 

Number  and  Percentage  of  Total  Deaths  from  Cancer  of  the  Breast  in  Each 
Color  and  Sex  Class. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Color  and  Sex. 

Number  of  Deaths. 

Per  Cent. 

All  classes  

3,579 

100.0 

White  males  

31 

.9 

White  females    

3,004 

83.9 

Colored  males      

9 

.3 

Colored  females  

535 

14.9 

In  view  of  this  very  small  number  of  male  deaths  from  cancer 
of  the  breast,  we  shall  concentrate  our  attention  entirely  upon  the 
statistics  for  white  and  colored  females.  The  following  table  gives 
the  death  rates  for  white  females  and  colored  females  at  the  several 
age  periods. 

*  Cancer  and  other  malignant  tumors. 


166 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


TABLE  100. 

MORTALITY  FROM  CANCER  OF  THE  BREAST-.    FEMALES  CLASSIFIED  BY  COLOR 
AND  BY  AGE  PERIOD. 

Death   Rates  per   100,000  Persons   Exposed.    1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


A  Re  Period. 

White  Females. 

Colored  Females. 

All  ages  —  one  and  over  

11.7 

14.7 

1  to  24  .  . 

f 

.1 

25  to  34  

2.5 

3.3 

35  to  44  

17.4 

18.9 

45  to  54  

36.9 

41.9 

55  to  64  

47.6 

59.9 

65  to  74  

76.0 

96.3 

75  and  over  

108.8 

118.0 

f  Less  than  .05  per  100,000. 

There  is  a  constantly  rising  death  rate  with  age  from  this  cause 
for  both  white  and  colored  females.  There  is  also  a  decided  excess 
in  the  death  rate  among  colored  over  white  females  although  this 
excess  among  colored  females  is  not  so  marked  as  it  was  for  cancer 
of  the  female  genital  organs. 

Throughout  the  six  years  under  examination,  there  was,  with 
the  exception  of  the  year  1915  for  colored  women,  little  devia- 
tion in  the  death  rate  for  cancer  of  the  breast.  In  the  following 
table,  we  quote  our  experience  for  each  of  the  years  from  1911  to 
1916: 

TABLE  101. 

MORTALITY  FROM  CANCER  OF  THE  BREAST.   FEMALES  CLASSIFIED  BY  COLOR. 
Death  Rates  per  100,000  Persona  Exposed.     Single  Tears  in  Period  1911 

to  1916. 


Experience  of  Metropolitan  Life  Insurance  Company. 
Department. 


Industrial 


Years. 

White  Females. 

Colored  Females. 

1911  to  1916      .  .            

11.7 

14.7 

1916   

11  8 

149 

1915   

125 

17  4 

1914          

11  4 

123 

1913        

11  9 

143 

1912  

12.1 

15.6 

1911  

10.2 

13.5 

CANCEB. 


167 


Cancer  of  the  breast  seems  not  to  have  as  heavy  a  mortality 
among  white  insured  females  as  it  does  among  females  in  the 
population  of  the  expanding  Registration  Area  of  the  United 
States.  Between  35  and  44  years,  there  is  practically  the  same 
death  rate  from  this  cause  in  each  experience.  But,  between  55 
and  64  years,  the  group  of  insured  females  in  wage  earners'  fami- 
lies shows  much  lower  death  rates  from  this  cause  than  were  found 
for  females  in  the  Registration  Area  of  the  United  States.  It 
should  be  recalled  at  this  point  that  the  data  for  the  expanding 
Registration  Area  comprise  a  small  proportion  of  colored  women. 
This  fact,  on  account  of  the  higher  death  rate  from  cancer  of  the 
breast  among  negro  women  than  among  white  women,  may  account 
in  some  measure  for  the  higher  mortality  from  this  cause  in  the 
population  experience  over  the  exclusively  white  insurance  experi- 
ence. The  following  table  affords  a  comparative  view  of  the  sta- 
tistics for  cancer  of  the  breast  among  insured  white  females  and 
among  females  in  the  general  population  of  the  expanding  Regis- 
tration Area: 

TABLE  102. 
MORTALITY  FROM  CANCER  OP  THE  BREAST. 

Death  Rates  per  100,000  Persons  Exposed.     Classified  by  Age  Period.    In* 
sured  White  Females  in  Experience  of  Metropolitan  Life  Insurance 
Company,  Industrial  Department  (1911  to  1916)  and  Females 
in  General  Population  Experience  of  Expanding  Regis- 
tration Area  of  the  United  States  (1910  to  1915). 


Age  Period. 

M.  L.  I.  CO. 
(White). 

U.  S.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 
of  Registration 
Area. 

All  ages  —  one  and  over  

11.7 

15.5 

75.5 

Under  25  

f 

.1 



25  and  over  

24.7 

29.7 

83.2 

25  to  34  

2.5 

2.7 

92.6 

35  to  44  

17.4 

17.5 

99.4 

45  to  54  

36.9 

41.3 

89.3 

55  to  64  

47.6 

61.0 

78.0 

65  to  74  

76.0 

81.0 

93.8 

75  and  over  

108.8 

130.6 

83.3 

t  Less  than  .05  per  100,000. 


168 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


CANCER*  OF  THE  PERITONEUM,  INTESTINES  AND  RECTUM. 

Cancer  of  the  intestines  constituted  the  very  largest  number  of 
the  4,482  deaths  under  this  head.  The  death  rates  by  age,  sex 
and  color  for  this  cause  are  shown  below: 

TABLE  103. 

MORTALITY  FROM  CANCER  OF  THE  PERITONEUM,  INTESTINES  AND  RECTUM. 
CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death   Sates   per   100,000   Persona   Exposed.    1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


White. 

Colored. 

Age  Period. 

Persons. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 

over  

8.3 

6.6 

10.5 

3.4 

7.2 

1  to  24. 

.4 

.4 

.3 

.2 

,3 

25  to  34  . 

2.2 

1.6 

2.2 

1.8 

3.9 

35  to  44  . 

7.8 

6.0 

8.8 

4.0 

11.7 

45  to  54 

22.1 

19.7 

25.8 

7.5 

19.9 

55  to  64  . 

43.9 

43.6 

50.5 

13.2 

21.1 

65  to  74  . 

83.1 

80.8 

95.0 

28.4 

31.7 

75  and  over 

109.5 

86.5 

130.6 

96.0 

36.3 

Mortality  from  this  form  of  cancer  also  increases  with  advanc- 
ing age.  White  males  show  lower  death  rates  at  all  significant 
ages  than  do  white  females.  The  colored  male  death  rate  from 
this  cause  is  also  decidedly  lower  than  the  rate  for  colored  females. 
It  would  be  well  to  recall  at  this  present  time  that  in  this  investiga- 
tion tuberculous  disease  of  the  abdominal  organs  also  shows  a 
higher  death  rate  among  females  of  both  white  and  colored  races, 
especially  at  the  ages  of  the  childbearing  period,  15  to  45  years. 
This  fact  suggests  the  possible  influence  of  puerperal  traumata  as 
contributing  causes  in  exciting  both  tuberculous  and  cancerous 
processes  in  the  main  adult  ages  among  females. 

At  the  ages  in  which  the  death  rate  from  cancer  of  the  peri- 
toneum, intestines  and  rectum  is  considerable,  insured  white  males 
show  higher  rates  than  do  males  in  the  general  population.  Be- 
tween 45  and  75  years  of  age,  the  excesses  in  the  rates  range  from 

*  Cancer  and  other  malignant  tumors. 


CANCER. 


169 


16  to  30  per  cent.  Insured  white  females,  on  the  other  hand, 
show  no  very  marked  tendency  to  depart  from  the  general  popula- 
tion experience.  At  some  age  periods,  the  death  rate  among  in- 
sured white  females  is  slightly  more  favorable  and  at  other  age 
periods  slightly  less  favorable  than  among  females  in  the  general 
population.  The  following  table  gives  a  comparative  view  of  the 
data  for  males  and  females  of  the  insurance  and  population  experi- 
ence, considered  according  to  age  period : 

TABLE  104. 
MORTALITY  FROM  CANCER  OP  THE  PERITONEUM,  INTESTINES  AND  BECTUM. 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Age  Period. 

.Males. 

Females. 

M.L.I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

M.L.I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

All  ae;es  —  one 
and  over  

Under  25.  .  . 
25  and  over. 

25  to  34.  ... 
35  to  44.... 
45  to  54.... 
55  to  64.... 
65  to  74.... 
75  and  over. 

6.6 

8.6 

76.7 

10.5 

10.4 

101.0 

.4 
16.9 

.5 

15.5 

80.0 
109.0 

.3 
21.9 

.3 

23.5 

100.0 
93.2 

1.6 
6.0 
19.7 
43.6 
80.8 
86.5 

2.1 
5.5 
15.2 
37.6 
67.6 
80.9 

76.2 
109.1 
129.6 
116.0 
119.5 
106.9 

2.2 

8.8 
25.8 
50.5 
95.0 
130.6 

2.6 
9.1 
24.6 
51.8 
89.5 
117.6 

84.6 
96.7 
104.9 
97.5 
106.1 
111.1 

The  data  indicate  a  practically  stationary  death  rate  from  this 
cause  between  1911  and  1916. 

OTHER  FORMS  OF  CANCER.* 

Discussion  in  great  detail  of  cancers  of  organs  and  parts  of  the 
body,  in  addition  to  those  covered  by  the  preceding  text,  is  not 
justified  for  many  reasons.  There  are,  however,  many  interesting 
and  important  age,  sex,  and  color  relations  disclosed  in  the  study 
of  "  other  cancers  "  which  should  not  be  passed  without  brief  com- 
ment. These  we  shall  discuss  briefly  in  relation  to  cancers  of  the 

*  Cancer  and  other  malignant  tumors. 


170          MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

buccal  cavity,  of  the  skin,  and  of  all  "  other  organs  or  of  organs 
not  specified"  in  the  order  named. 

Cancer*  of  the  Buccal  Cavity. 

Cancer  of  the  buccal  cavity,  including  cancer  of  the  maxillae, 
caused  1,353  deaths  during  the  six  year  period  1911  to  1916.  This 
corresponds  to  a  death  rate  of  2.5  per  100,000  exposed.  Of  the 
1,353  deaths,  1,229.  were  those  of  white  policyholders  and  124  of 
colored  persons.  The  death  rate  per  100,000  exposed  was  2.6  for 
white  lives  as  compared  with  1.9  for  colored  lives.  Cancer  of  the 
buccal  cavity  shows  a  very  strong  sex  incidence.  Of  the  1,353 
deaths,  1,064  were  those  of  males  and  only  289  those  of  females. 
This  excess  among  males  applies  to  both  white  and  colored  lives; 
especially  to  the  former,  among  whom  male  mortality  (4.6)  was 
more  than  five  times  that  of  females  (.9).  White  males  show  a 
death  rate  almost  twice  that  for  colored  males  (4.6  as  compared 
with  2.5).  In  the  female  experience  the  rate  for  colored  women 
(1.3)  exceeds  that  for  insured  white  women  (.9).  This  compari- 
son for  colored  policyholders,  however,  is  hardly  valid  on  account 
of  the  small  number  of  deaths  involved. 

The  great  majority  of  the  deaths  classified  as  due  to  cancer  of 
the  buccal  cavity  were  reported  under  the  terms  "cancer  of  the 
jaw,"  "  cancer  of  the  tongue,"  "  cancer  of  the  lip,"  and  "  cancer  of 
the  mouth  "  without  more  definite  designation. 

There  is  no  pronounced  upward  or  downward  trend  shown  for 
cancer  of  the  buccal  cavity  in  the  Industrial  experience  of  this 
Company  during  the  six  year  period  covered  by  this  report.  The 
death  rate  was  2.3  per  100,000  exposed  in  the  first  year  of  the 
sexennium  as  compared  with  2.4  for  the  last  year.  The  rates  in 
the  general  population  are  slightly  higher  than  those  for  the  in- 
sured. This  is  accounted  for  largely  by  differences  in  the  age 
distribution  of  the  two  populations.  As  a  general  proposition  only 
5  per  cent,  of  the  deaths  from  this  disease  occur  among  persons 
under  50  years  of  age.  The  great  bulk  of  the  deaths  are  those  of 
men  between  the  ages  of  50  and  79. 

Cancer*  of  the  Skin. 

Skin  cancers  were  reported  as  causes  of  death  in  938  cases  in 
the  mortality  experience  of  insured  wage  earners  covering  the  six 
*  Cancer  and  other  malignant  tumors. 


CANCER.  171 

year  period  1911  to  1916,  corresponding  to  a  death  rate  of  1.7  per 
100,000  exposed.  Little  fluctuation  is  shown  in  the  rate  when  the 
years  of  the  period  are  compared  with  one  another.  Cancer  of  the 
skin  is,  almost  altogether,  confined  to  white  persons.  In  the 
Metropolitan  experience  887  of  the  938  deaths  were  those  of  white 
persons,  the  total  white  death  rate  being  1.9  per  100,000  exposed  as 
compared  with  .8  for  the  colored  insured.  In  the  matter  of  sex 
incidence  a  considerable  excess  in  the  white  experience  is  shown 
for  males  over  females;  the  rate  for  the  former  being  2.2  as  com- 
pared with  1.6  for  the  latter.  The  rates  for  colored  policy  holders 
are  not  so  significant  when  compared  by  sex  on  account  of  the 
small  number  of  deaths  involved. 

As  with  cancers  of  the  buccal  cavity,  only  a  comparatively  small 
percentum  of  the  deaths  from  skin  cancers  are  those  of  persons 
under  50  years  of  age.  The  mortality  is  bulked  between  the  ages 
of  60  and  79  years.  When  we  compare  buccal.and  skin  cancers  by 
age  groups  we  find  that  there  is  a  much  higher  mortality,  rela- 
tively, from  the  skin  cancers  in  extreme  old  age  than  from  cancers 
of  the  buccal  cavity. 

A  lower  death  rate  at  all  ages  for  this  form  of  cancer  is  found 
among  the  insured  than  among  the  general  population.  The  same 
explanation  for  this  obtains  as  for  cancer  of  the  buccal  cavity, 
namely,  the  lower  average  age  of  the  group  of  policyhplders. 
Like  that  of  the  insured  group,  the  general  population  experience 
for  this  cause  of  death  shows  little  change  in  the  rate  during  the 
sexennium  to  which  this  report  relates.  The  great  majority  of  the 
deaths  charged  to  this  title  heading  were  reported  in  one  of  the 
following  ways :  cancer  of  the  face,  cancer  of  the  nose,  cancer  of  the 
skin,  rodent  ulcer,  and  epithelioma  (location  not  indicated). 

Cancer  and  Other  Malignant  Tumors  of  Other  Organs  or  of 
Organs  not  Specified. 

The  above  is  a  residual  heading  under  which  are  classified  all 
deaths  from  cancers  that  cannot  be  definitely  assigned  to  one  of 
the  preceding  titles;  it  also  includes  cancers  in  which  no  statement 
is  given  of  the  location  or  original  seat  of  the  disease.  The  more 
definite  titles  included  are  the  cancers  of  the  bladder,  of  the  pros- 
tate, of  the  pancreas,  of  the  kidney  and  suprarenals,  of  the  lung 


172          MORTALITY    STATISTICS   OF   INSURED   WAGE   EABNERS. 

and  pleura,  of  the  bones  (jaw  excepted),  of  the  larynx,  of  the 
brain,  of  the  testes,  of  the  parotid  gland,  and  of  the  spleen. 

This  title  constitutes  an  important  cause  of  death  numerically 
in  the  present  experience.  No  fewer  than  5,279  deaths  were 
charged  to  it  and  the  corresponding  rate  was  9.8  per  100,000  ex- 
posed. With  the  exception  of  cancer  of  the  stomach  and  liver,  and 
cancer  of  the  female  genital  organs,  more  deaths  are  charged  to 
this  residual  title  than  to  any  of  the  other  separate  headings  relat- 
ing to  malignant  growths. 

There  was  only  a  very  small  fluctuation  in  the  death  rate  during 
the  several  years  which  constitute  the  period  to  which  this  report 
relates.  This  same  phenomenon  is  in  evidence  for  the  expanding 
Registration  Area  of  the  United  States.  The  death  rate  for  this 
cause,  however,  is  considerably  higher  in  the  latter  experience  for 
these  forms  of  cancer  than  among  the  insured  group. 

The  total  death  rate  for  the  insured  white  experience  was  10.1 
per  100,000  exposed  as  compared  with  7.6  for  the  colored  experi- 
ence. In  each,  the  mortality  among  males  was  higher  than  among 
females,  although  this  is  much  more  pronounced  among  the  white 
policyholders  than  among  the  colored.  This  excess  for  males  is 
accounted  for,  in  part,  by  the  fact  that  all  deaths  from  cancers  of 
the  male  genitals  are  classified  under  this  heading. 


CHAPTER   X. 
CEREBRAL  HEMORRHAGE  AND  APOPLEXY. 

Cerebral  hemorrhage  and  apoplexy  may  be,  in  many  cases,  the 
terminal  stages  of  several  underlying  diseases  of  the  cardio- 
vascular-renal system.  Unfortunately,  classification  procedure  is 
still  rather  unsettled  with  reference  to  the  assignment  of  the  cause 
in  cases  of  terminal  cerebral  hemorrhage  and  apoplexy,  even  when 
the  primary  disease  of  the  heart,  blood  vessels  or  renal  tract  is 
mentioned.  In  some  cases  the  hemorrhage  is  preferred  in  the  sta- 
tistical registration  of  the  death ;  in  other  cases  precedence  is  given 
to  the  antecedent  condition.  But  in  many  cases  no  mention  of  the 
primary  disease  is  made  by  the  physician  and  this  probably  ex- 
plains the  large  number  of  deaths  which  are  annually  'ascribed  to 
cerebral  hemorrhage  and  apoplexy  in  most  mortality  reports. 
Often  these  deaths  are  sudden  ones  and  are  certified  by  coroners 
or  by  their  physicians,  who  see  the  cases  only  after  death  and  who 
are  guided  by  the  clinical  picture  of  an  apoplexy.  Much  uncer- 
tainty, therefore,  still  surrounds  the  statistics  of  this  disease,  and 
of  its  underlying  causes,  especially  when  we  consider  that  only  a 
very  small  proportion  of  the  certifications  are  confirmed  by  the 
findings  at  autopsy.  The  figures  for  cerebral  hemorrhage  and 
apoplexy  may  be  subject  to  very  considerable  revision  in  the  future. 

In  the  six  year  period  36,638  deaths  were  assigned  to  this  cause 
in  the  Industrial  experience.  This  corresponds  to  an  annual  aver- 
age rate  of  68.1  per  100,000  exposed.  The  condition  stands  seventh 
in  numerical  importance  in  our  list,  accounting  for  5.8  per  cent, 
of  all  the  deaths.  We  shall  see  later  that  this  condition  is  much 
more  important  with  reference  to  the  advanced  age  periods  of  life. 
The  table  on  page  174  shows  the  death  rates  by  color,  sex  and  by 
age  period. 

There  is  no  considerable  mortality  from  this  cause  under  25 
years  of  age.  Beginning  with  the  age  period  25  to  34  years  there 
is  the  significant  mortality  rate  of  8.9  per  100,000  persons  exposed. 
Between  35  and  44  years  a  death  rate  of  35.9  per  100,000  is  found 
and  thereafter  the  figures  increase  very  rapidly,  nearly  trebling  in 

173 


174 


MORTALITY    STATISTICS  OF   INSURED    WAGE   EARNERS. 


TABLE  105. 
MORTALITY  FROM  CEREBRAL  HEMORRHAGE  AND  APOPLEXY,  CLASSIFIED  BY 

COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death    Eates   per   100,000   Persons   Exposed.     1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


\ 

I'hite. 

O 

•lor.*! 

Age  Period. 

Persons. 

Matea. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

68.1 

60.2 

69.5 

76.9 

97.4 

1  to  4  

3.1 

2.5 

2.9 

7.7 

7.6 

5  to  9  

.7 

.7 

.6 

2.9 

.6 

10  to  14  

.8 

.8 

.5 

1.6 

2.2 

15  to  19   .... 
20  to  24  

1.6 
2.9 

1.2 
2.5 

1.4 
2.3 

2.9 
5.9 

5.0 
7.4 

25  to  34  

8.9 

8.7 

6.5 

18.9 

14.4 

35  to  44  

35.9 

33.8 

28.3 

54.8 

65.7 

45  to  54  

130.6 

123.2 

113.6 

185.7 

223.0 

55  to  64  

359.0 

377.5 

323.0 

423.2 

483.7 

65  to  74  

918.4 

979.0 

877.7 

855.3 

979.5 

75  and  over  .  . 

1841.5 

2011.7 

1775.5 

1605.2 

1624.2 

some  cases,  until  the  maximum  rate,  1841.5,  is  attained  for  the 
period  75  years  and  over. 

The  rate  varies  with  color  and  sex.  Colored  persons  show  a  rate 
for  each  of  the  sexes  which  is  at  some  age  periods  more  than  twice 
the  death  rate  of  white  persons  of  the  same  sex  group.  With  in- 
creasing age,  however,  the  excess  of  colored  mortality  becomes  less 
marked.  Indeed,  for  the  age  period  65  to  74  years,  the  rate  for 
white  males  is  higher  than  that  for  colored  males,  and  at  the  ex- 
treme of  life,  ages  75  and  over,  the  rate  for  the  colored  of  each  sex 
is  the  lower.  In  each  color  group  at  all  ages  combined  the  females 
show  a  higher  rate  than  the  males.  This  condition  is  particularly 
marked  among  colored  lives.  Analyzing  by  age  period,  however,  we 
find  an  interesting  difference  between  the  two  races.  The  higher 
rate  for  white  females  at  all  ages  one  and  over  combined  is  evi- 
dently due  to  the  higher  average  age  of  the  living ;  the  specific  rates 
are  lower  at  each  age  period,  practically,  than  those  for  white  males. 
Among  the  colored,  on  the  other  hand,  a  different  situation  occurs, 
for  in  this  group  the  rate  for  females  is,  with  but  one  exception, 
higher  than  that  for  males  beginning  with  the  period  10  to  14 
years.  The  excess  is  marked  in  the  significant  periods  of  middle 
life  and  old  age. 


CEEEBRAL   HEMORRHAGE  AND  APOPLEXY.  175 

The  above  variations  in  the  death  rate  according  to  color  must  not 
be  stressed  too  much  because  of  the  element  of  uncertainty  in  the 
statistical  treatment  of  statements  of  this  cause  of  death.  It  must 
be  remembered  that  the  higher  rate  for  colored  persons  may  be 
partly  explained  by  the  fact  that  this  race  has  not  as  yet  available 
for  its  service  a  medical  practice  of  as  high  standards  as  has  the 
white  race.  This  latter  fact  would  naturally  result  in  a  larger 
number  of  certifications  of  "  hemorrhage  of  brain  "  instead  of  more 
specific  certifications  of  underlying  diseases  of  the  cardio-vascular- 
renal  tract.  There  is  sufficient  excess,  however,  in  the  colored  over 
the  white  rates  to  justify  a  conclusion  that  negroes  suffer  from 
cerebral  hemorrhage  and  apoplexy  somewhat  more  than  white 
people.  We  may  also  safely  conclude  that  negro  women  die  from 
this  cause  more  frequently  than  do  negro  men  at  middle  and 
advanced  life. 

Our  present  array  of  statistics  does  not  give  a  true  picture  of  the 
importance  of  cerebral  hemorrhage  and  apoplexy  at  the  advanced 
years  of  life,  because  only  a  small  proportion  of  policyholders  are 
represented  after  age  65.  It  will  be  instructive  to  refer  at  this 
point  to  a  special  study  which  was  made  of  population  mortality 
statistics  of  old  age.*  In  that  report  it  was  pointed  out  that 
cerebral  hemorrhage  and  apoplexy  in  the  population  of  the  Regis- 
tration Area  of  the  United  States  is  a  most  important  cause  of 
death  during  old  age.  In  fact,  beyond  age  65  this  condition  causes 
more  than  one  death  in  every  eight. 

The  table  on  page  176  presents  a  comparison  of  the  death  rates  of 
the  general  population  in  the  expanding  Registration  Area  for  1910 
to  1915  by  sex  and  by  age  period  with  those  for  insured  white 
lives,  1911  to  1916. 

We  find,  in  general,  higher  mortality  among  insured  wage  earners 
than  in  the  general  population.  Thus,  between  45  and  54  years, 
insured  white  male  wage  earners  show  a  death  rate  of  123.2  which 
is  141  per  cent,  of  the  rate  for  males  in  the  general  population 
(87.4  per  100,000).  Between  55  and  64  years,  white  males  in 
the  insurance  experience  registered  a  rate  of  377.5  per  100,000  ex- 
posed, as  compared  with  276.1  per  100,000  among  males  in  the 
general  population.  Practically  similar  excesses  in  the  death  rates 
of  insured  white  females  were  observed.  It  should  be  recalled  in 

*  Dublin,  Louis  I.,  "The  Vital  Statistics  of  Old  Age,"  New  York  Medical 
Journal,  May  19,  1917. 


176 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


TABLE  106. 
MORTALITY  FROM  CEREBRAL  HEMORRHAGE  AND  APOPLEXY. 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Male*. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  

60.2 

76.6 

78.6 

69.5 

77.7 

89.4 

1  to  4... 

2.5 

2.5 

100.0 

2.9 

2.4 

120.8 

5  to  9... 

.7 

.9 

77.8 

.6 

.9 

66.7 

10  to  14.. 

.8 

.9 

88.9 

.5 

.8 

62.5 

15  to  19.  . 

1.2 

1.8 

86.7 

1.4 

1.5 

93.3 

20  to  24.. 

2.5 

2.9 

86.2 

2.3 

2.6 

88.5 

25  to  34.. 

8.7 

7.4 

117.6 

6.5 

6.3 

103.2 

35  to  44.. 

33.8 

25.2 

134.1 

28.3 

23.9 

118.4 

45  to  54.. 

123.2 

87.4 

141.0 

113.6 

92.7 

122.5 

55  to  64.. 

377.5 

276.1 

136.7 

323.0 

255.0 

126.7 

65  to  74.. 

979.0 

709.0 

138.1 

877.7 

648.7 

135.3 

75  and  over 

2011.7 

1610.2 

124.9 

1775.5 

1622.2 

109.5 

making  this  comparison,  however,  that  a  considerably  larger  pro- 
portion of  deaths,  originally  reported  by  physicians  as  due  to 
"paralysis  without  specified  cause,"  are  assigned  upon  special  in- 
quiry to  cerebral  hemorrhage  and  apoplexy  in  the  insurance  ex- 
perience than  in  the  population  experience.  This  factor,  we  be- 
lieve, is  not  powerful  enough,  however,  to  account  for  all  of  the  dif- 
ferences in  the  two  series  of  death  rates  for  this  particular  cause. 
There  is  still  a  significant  excess  remaining  in  the  death  rates  of 
male  and  female  white  insured  wage  earners. 

Trend  of  the  Death  Rate  from  Cerebral  Hemorrhage  and  Apoplexy. 

Considering  all  the  influences  at  work  that  affect  the  registered 
death  rate  for  cerebral  hemorrhage  and  apoplexy,  it  may  be  said 
that  no  well-defined  upward  or  downward  tendency  can  be  dis- 
cerned in  the  mortality  from  this  disease  in  recent  years.  There 
was  a  marked  increase  in  the  death  rate  between  1911  and  1912,  but 
this  is,  in  all  probability,  due  to  the  inauguration  in  the  Statistical 
Bureau  of  the  system  of  inquiry  into  returns  of  "paralysis."  It 


CEREBRAL    HEMORRHAGE   AND   APOPLEXY. 


177 


will  be  seen  that  since  1912,  during  which  time  this  inquiry  prac- 
tice as  to  "  paralysis "  was  carried  out  uniformly  with  vigor,  there 
has  been  no  significant  variation  in  the  death  rate  from  this  cause, 
from  an  average  of  about  68  deaths  per  100,000  persons  exposed. 
There  is  an  apparently  heavier  rate  among  both  colored  males  and 
females  in  the  later  than  in  the  earlier  years  of  this  experience. 
This  fact  is  accounted  for,  to  some  extent,  in  our  opinion,  by 
gradually  improving  statements  of  diagnosis  on  the  death  cer- 
tificates of  colored  policyholders  and  does  not  indicate,  we  believe, 
any  actual  change,  among  colored  persons  in  the  conditions  causing 
the  disease.  "  Paralysis "  without  further  definition  was  at  one 
time  in  this  experience  a  very  common  return  of  cause  of  death 
in  the  case  of  colored  persons.  This  report  is  not  now  relatively  so 
frequent.  The  facts  for  each  of  the  calendar  years  in  this  experi- 
ence are  shown  in  the  following  table : 

TABLE  107. 

MORTALITY  FROM  CEREBRAL  HEMORRHAGE  AND  APOPLEXY,  CLASSIFIED  BY 

COLOR  AND  BY  SEX. 

•Death  Bates  per  100,000  Persons  Exposed.     Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

191110  1916  
1916  

68.1 

60.2 

69.5 

76.9 

97.4 

68.7 
68.5 
69.2 
67.2 
70.3 
64.2 

58.8 
60.1 
59.9 
59.9 
63.5 
•59.8 

70.1 
68.1 
72.0 
68.4 
72.2 
65.4 

80.2 
83.5 
76.7 
74.9 
77.3 
67.5 

110.4 
109.8 
98.4 
94.8 
89.8 
77.5 

1915  

1914  

1913  

1912  

1911  

13 


CHAPTER  XL 
THE  FOUR  PRINCIPAL  COMMUNICABLE  DISEASES  OP  CHILDHOOD. 

The  four  principal  communicable  diseases  of  childhood,  namely, 
measles,  scarlet  fever,  whooping  cough  and  diphtheria  constitute 
an  interesting  group  for  detailed  study  and  analysis.  Together, 
they  were  responsible  for  a  total  of  25,578  deaths  during  the  six 
year  period  or  for  4  per  cent,  of  the  entire  mortality.  If  related  to 
the  period  of  childhood  where  nearly  all  of  these  deaths  occur, 
their  importance  is  more  obvious;  for  they  caused  24.2  per  cent, 
of  all  the  deaths  among  children  under  age  15.  Even  this  high 
proportion  is  increased  as  we  examine  the  conditions  in  the  still 
earlier  age  periods. 

These  diseases  and  conditions  are  all  characterized  by  their  wide 
geographic  distribution,  their  highly  infectious  character  and, 
usually,  by  their  low  lethal  rates.  They  are,  preeminently,  dis- 
eases subject  to  public  health  control.  In  fact  they  show  clearly 
the  effect  of  such  control  in  their  rapidly  declining  relative  numer- 
ical importance  as  causes  of  death.  While  the  decreases  in  the 
death  rates  are  not  always  continuous,  they  are  nevertheless  sub- 
stantial, when  the  entire  six  year  period  is  considered.  Further- 
more, the  rates  give  considerable  promise  of  further  reduction  as 
the  diseases  come  under  more  complete  public  health  control. 

These  four  diseases  possess  certain  interesting  statistical  char- 
acteristics in  common.  In  the  case  of  each,  the  mortality  was 
higher  in  the  earliest  age  period,  1  to  4  years,  than  in  any  other 
age  group.  This  characteristic  is  most  pronounced  with  whooping 
cough.  The  death  rates  rapidly  decline  from  the  first  age  period, 
but  continue  to  show  appreciable  figures  throughout  the  period  of 
childhood.  With  the  single  exception  of  whooping  cough,  these 
diseases  show  higher  urban  than  rural  rates  in  populations  gen- 
erally. With  the  exception  of  whooping  cough  again,  they  have  a 
higher  incidence  among  males  than  among  females  and  much 
higher  incidences  among  white  children  than  among  colored  chil- 
dren. In  fact,  diphtheria,  scarlet  fever  and  measles  are  not  very 

178 


PRINCIPAL   COMMUNICABLE   DISEASES   OF    CHILDHOOD. 


179 


serious  causes  of  death  among  colored  children.  Whooping  cough, 
on  the  other  hand,  shows  a  small  excess  for  females  and  a  death 
rate  almost  twice  as  high  for  colored  as  for  white  children  of  each 
age  group. 

We  shall  consider  these  causes  individually  in  the  following 
order:  measles,  scarlet  fever,  whooping  cough  and  diphtheria. 

(a)  MEASLES. 

This  disease  is  defined  as  an  acute  and  highly  contagious  fever 
with  specific  localization  in  the  upper  air  passages  and  in  the  skin. 
It  ranks  second  to  diphtheria  as  a  cause  of  death  among  the  four 
principal  communicable  diseases  of  children.  As  a  cause  of  sick- 
ness it  is  probably  the  most  widespread  of  all  the  communicable 
diseases;  but  this  is  compensated  by  its  usually  low  lethal  rate. 
In  fatal  cases,  death  is  usually  due  to  respiratory  complications; 
more  particularly  to  bronchopneumonia.  It  is  frequently  followed 
in  non-fatal  cases  by  otitis  media,  and  indeed,  a  considerable  pro- 
portion of  the  deafness  in  the  country  has  been  traced  to  ear  disease 
secondary  to  measles. 

Measles,  like  most  diseases  with  skin  manifestations,  shows  a 
much  higher  death  rate  among  white  persons  than  among  colored 
people.  As  will  be  observed  in  the  table  below,  the  excess  in  the 
white  rate  is  most  marked  in  the  period  under  5  years.  Thereafter 
the  differences  are  minor  and,  in  fact,  after  age  10  the  rates  for 
colored  persons  are  higher  than  for  white  persons.  It  is  true  that 
the  number  of  deaths  at  the  ages  after  age  10  is  very  small. 

TABLE  108. 
MORTALITY  FROM  MEASLES,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death   Hates  per  100,000  Persons  Exposed.    1911   to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


White. 

Colored. 

Age  Period. 

Persons. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 

over  

8.9 

10.5 

8.6 

5.2 

4.8 

Ito4.... 

81.1 

84.1 

80.0 

68.6 

67.3 

5  to  9.... 

10.9 

10.5 

11.4 

9.7 

11.2 

10  to  14.  .  . 

1.7 

1.3 

1.9 

2.2 

3.4 

15  to  19... 

1.1 

1.0 

.9 

2.9 

2.1 

20  and  over 

.5 

.3 

.6 

.4 

.6 

180 


MORTALITY    STATISTICS   OP   INSURED   WAGE   EARNERS. 


The  death  rate  is  higher,  also,  among  males  than  among  females. 
This  applies  especially  to  the  age  period  1  to  4  years  in  which  75 
per  cent,  of  the  measles  deaths  among  insured  children  occur.  The 
age  at  which  the  highest  mortality  occurs  is  the  second  year  of 
life;  with  this  exception,  the  largest  number  of  deaths  in  popula- 
tions generally  occur  among  infants  under  one  year  of  life.  The 
deaths  of  infants  do  not  enter  into  this  study,  however,  since 
persons  are  not  insured  until  after  the  close  of  the  first  year  of  life. 

The  table  on  page  179  presents  the  death  rates  by  color,  eex  and 
age  period  for  this  disease. 

Very  similar  relations  are  found  in  the  death  rates  of  children 
from  measles  according  to  sex  and  age  in  the  general  population  of 
the  expanding  Registration  Area,  although  the  actual  death  rates 
by  age  period  and  sex  are  slightly  different  from  those  found  in 
the  insurance  experience.  The  measles  death  rate  in  the  general 
population  is  considerably  lower  than  that  for  the  insured  group. 
This  is  quite  marked  in  the  two  age  periods  under  10  years.  After 
10  years,  the  reverse  condition  holds,  but  no  great  significance  can 
be  attached  to  the  figures.  There  are  obvious  reasons  why  the 
death  rate  among  insured  children  should  be  higher  than  for  chil- 
dren in  the  general  population.  In  the  first  place,  insured  children 
are  almost  entirely  urban  residents  and  the  urban  death  rate  is 
about  double  the  rural  rate  for  this  disease.  The  population  of 

TABLE  109. 
MORTALITY  FROM  MEASLBS. 

Death  Sates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Age  Period. 

Males. 

Females. 

M.L.I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

M.L.I.  Co. 
(Whit*). 

U.  8.  Reg. 

Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

AH  ages  —  one 
and  over  

1  to  4  
5  to  9  
10  to  14.... 
15  to  19.... 
20  and  over. 

10.5 

6.8 

154.4 

8.6 

7.1 

121.1 

84.1 
10.5 
1.3 
1.0 
.3 

63.4 

7.7 
1.9 
1.8 
.7 

132.6 
136.4 
68.4 
55.6 
42.9 

80.0 
11.4 
1.9 
.9 
.6 

59.8 
7.8 
2.5 
1.8 
1.2 

133.8 
146.2 
76.0 
50.0 
50.0 

PRINCIPAL   COMMUNICABLE  DISEASES   OF   CHILDHOOD. 


181 


the  Registration  Area  is  about  equally  divided  between  the  urban 
and  rural  communities.  Another  factor  favoring  the  Registra- 
tion Area  is  the  inclusion  in  the  latter  of  a  small  proportion  of 
colored  lives  whose  death  rates  from  measles  are  lower  than  those 
for  whites.  The  table  on  page  180  permits  a  more  detailed  com- 
parison of  the  two  sets  of  figures  by  age  and  sex. 

The  mortality  from  measles  has  been  showing  marked  fluctua- 
tions in  recent  years.  This  tendency  has  been  observed  in  both 
the  general  population  and  the  insured  group.  The  year  1915 
marked  the  minimum  death  rate  for  this  disease  in  both  experi- 
ences. For  that  year  the  rate  was  5.7  per  100,000  exposed  for 
Metropolitan  Industrial  policyholders  aged  one  year  or  more  and 
5.4  per  100,000  exposed  for  the  general  population  at  all  ages.  In 
this  comparison  the  rates  include  both  white  and  colored  children 
among  the  insured.  The  year  1915,  it  may  be  remarked,  showed 
the  lowest  death  rate  recorded  for  measles  for  the  general  popu- 
lation since  the  beginning  of  the  period  covered  by  the  annual  mor- 
tality reports  relating  to  the  expanding  Registration  Area.  The 
year  1916,  however,  showed  a  pronounced  increase  in  both  experi- 
ences, although  this  was  not  as  marked  among  the  insured  group  as 
it  was  for  the  expanding  Registration  Area,  in'  which  the  death 
rate  more  than  doubled.  The  following  table  shows  the  trend  of 
the  mortality  among  white  and  colored  policyholders  by  sex  during 
the  period  1911  to  1916: 

TABLE  110. 

MORTALITY  FROM  MEASLES,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.     Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

8.9 

10.5 

8.6 

5.2 

4.8 

1916  

9.9 
5.7 
6.9 
12.3 
7.6 
11.4 

12.2 
6.5 
8.1 
14.2 
9.3 
13.0 

9.4 
5.9 
6.5 
12.1 
7.2 
10.5 

4.0 

2.3 
4.8 
7.6 
3.9 
9.4 

3.5 
2.4 
4.0 
6.5 
3.6 
9.2 

1915  

1914  

1913  

1912  

1911  

182         MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

Comparisons  of  the  death  rate  for  this  disease  covering  long 
periods  of  years  should  be  made  only  with  certain  reservations. 
In  fatal  cases  usually  the  complications  and  sequelae  are  the  im- 
mediate causes  of  death.  Only  a  few  years  ago  there  was  very 
great  understatement  of  this  condition  on  reports  of  causes  of 
death.  This  situation  has  been  gradually  improved  through  the 
efforts  of  National,  state  and  corporate  bureaus  interested  in  mor- 
tality statistics.  Year  after  year  increasing  numbers  of  physicians 
have  learned  the  importance  of  stating  primary  conditions  instead 
of  sequelae  and  terminal  complications  as  determining  causes  of 
death.  Measles  is  one  of  the  diseases  the  published  death  rates 
for  which  have  been  very  materially  affected  by  this  influence. 
No  doubt  there  is  still  some  understatement  but  the  condition  has 
shown  very  great  improvement.  Those  who  make  comparisons  and 
analyses  based  on  the  published  death  rates  for  this  disease  should 
make  due  allowance  for  the  influence  of  these  factors. 

(&)  SCARLET  FEVER. 

Probably  there  have  been  few  more  gratifying  evidences  of  the 
effectiveness  of  public  health  activity  in  this  country  than  the  con- 
sistent decrease  in  scarlet  fever  mortality.  The  attention  given 
by  public  health  officials  to  prophylaxis,  the  increasing  rigidity  of 
school  inspection,  the  education  of  the  public  on  the  necessity  of 
care  and  precaution  against  the  spread  of  the  disease,  have  all  been 
potent  factors  in  lowering  the  mortality  from  scarlet  fever.  There 
has  also  been  more  widespread  public  appreciation,  not  only  of  the 
more  or  less  immediately  fatal  results,  but  of  the  serious  sequelae 
of  the  disease. 

There  were  4,638  deaths  from  scarlet  fever  among  Metropolitan 
Industrial  policyholders  during  the  period  1911  to  1916.  The 
death  rate  was  8.6  per  100,000  exposed. 

The  death  rate  among  white  policyholders,  both  male  and  female, 
was  about  four  times  as  high  as  that  for  the  colored  policyholders. 
This-  is  a  condition  which  has  also  obtained,  year  by  year,  for  the 
population  of  the  expanding  Registration  Area.  The  comparative 
immunity  of  colored  persons  to  this  disease  has  long  been  recog- 
nized. The  sex  incidence  for  the  insured  shows  a  heavier  com- 
parative death  rate  for  males  over  females  among  white  policy- 
holders  than  among  colored  ones.  The  colored  experience,  how- 
ever, is  small,  and  this  comparison  is,  possibly,  not  significant. 


PRINCIPAL   COMMUNICABLE  DISEASES   OF   CHILDHOOD. 


183 


The  age  period  of  heaviest  mortality,  in  the  Metropolitan  experi- 
ence, is  the  period  1  to  4  years,  during  which  ages  2,210  deaths  or 
47.6  per  cent,  of  the  total  of  4,638  deaths  occurred.  The  follow- 
ing table  gives  the  death  rates  by  age  period  for  each  color  and  sex 
class : 

TABLE  111. 

MORTALITY  PROM  SCARLET  FEVER,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE 

PEKIOD. 

Death   Bates   per   100,000   Persons   Exposed.     1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

8.6 

10.6 

8.6 

2.5 

2.2 

1  to  4  

49.0 
22.5 
6.4 
2.8 
1.6 
.5 

53.5 
24.3 
5.8 
3.0 
1.2 
.4 

48.8 
23.4 
7.5 
2.9 
2.2 
.6 

16.0 
8.8 
5.1 
1.0 

.2 

22.2 
6.4 
2.5 
2.3 
.5 
.3 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  and  over.  . 

The  sex  and  age  characteristics  brought  out  by  examining  the 
comparable  figures  for  the  expanding  Eegistration  Area  (with  the 
population  under  one  year  eliminated)  do  not  differ  materially 
from  those  shown  above  for  the  Metropolitan  experience.  It  is  true 
that  the  slight  excess  which  is  recorded  among  insured  males  over 
females  is  not  in  evidence  for  the  general  population.  In  the 
latter  experience  the  mortality  rate  for  the  period  1910  to 
1915  for  males  was  7.1  per  100,000  population;  this  corresponds 
closely  to  the  rate  shown  for  females  (7.5).  For  the  age  period 
1  to  4  years  the  insured  white  male  children  show  a  higher  rate 
(53.5  per  100,000  exposed)  than  is  in  evidence  for  those  of  the 
same  age  group  in  the  general  population  (45.8) ;  the  insured 
females  of  this  age  group  show  about  the  same  excess  over  the 
females  in-  the  general  population  (48.8  as  compared  with  42.8). 
In  the  age  period  5  to  9  years  the  insured  white  males  registered  a 
higher  death  rate  than  did  the  males  of  the  general  population  and 
the  insured  white  females  also  showed  a  very  slight  excess.  It 
must  be  borne  in  mind,  however,  in  making  this  comparison,  that 


184 


MORTALITY    STATISTICS   OF    INSURED   WAGE   EARNERS. 


the  colored  population  in  the  expanding  Registration  Area  is  in- 
cluded, and  that  on  account  of  the  extremely  low  incidence  of 
scarlet  fever  among  colored  people  it  is  probable  that  their  in- 
clusion in  the  exposure  accounts  for  a  considerable  share  of  the 
excess  which  is  shown  for  the  insured  white  children.  Another 
element  which  should  be  considered  in  comparing  the  mortality 
from  this  disease  among  insured  children  and  those  of  the  general 
population  is  the  far  higher  proportion  of  urban  exposure  among 
the  policyholders.  The  mortality  reports  covering  the  general 
population  show,  year  after  year,  considerably  higher  death  rates 
for  scarlet  fever  in  the  cities  than  in  the  rural  communities,  and 
the  rates  for  the  insured  do  not  have  the  benefit  of  much  rural  ex- 
posure. The  following  table  shows,  side  by  side,  the  figures  for 
males  in  the  expanding  Registration  Area  compared  with  those  for 
white  insured  males;  also  the  figures  for  females  in  the  Registra- 
tion' Area  compared  with  those  for  white  insured  females : 

TABLE  112. 

MORTALITY  FROM  SCARLET  FEVER. 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Eegistra- 
tion  Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  CO. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I  Co 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  aees  —  one 

and  over  

10.6 

7.1 

149.3 

8.6 

7.5 

114.7 

Ito4... 

53.5 

45.8 

116.8 

48.8 

42.8 

114.0 

5  to  9... 

24.3 

22.0 

110.5 

23.4 

23.1 

101.3 

10  to  14.. 

5.8 

6.0 

96.7 

7.5 

7.1 

105.6 

15  to  19.. 

3.0 

2.8 

107.1 

2.9 

3.1 

93.5 

20  to  24.. 

1.2 

1.6 

75.0 

2.2 

2.2 

100.0 

25  and  over 

.4 

.6 

66.7 

.6 

.7 

85.7 

The  highest  death  rate  during  the  period  for  Metropolitan  In- 
dustrial policyholders  was  that  for  the  year  1911  (13.1) ;  the 
death  rate  for  1913  was  12.7;  for  1914,  9.8;  for  1912,  9.0.  For 
the  yeai  1915  there  was  a  decrease  to  4.6  and  this  was  followed  by 
a  further  decline  in  1916  to  4.1. 


PRINCIPAL   COMMUNICABLE  DISEASES   OF   CHILDHOOD. 


185 


This  experience  corresponds  closely  to  that  of  the  Registration 
Area.  The  trend  of  the  mortality  due  to  scarlet  fever  during  the 
period  1911-1916  among  Metropolitan  Industrial  policyholders  is 
shown  by  the  following  table: 

TABLE  113 
MORTALITY  FROM  SCARLET  FEVER  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.     Single  fears  in  Period  1911 

to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company,  Industrial  Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

8.6 

10.6 

8.6 

2.5 

2.2 

1916 

4.1 
4.6 
9.8 
12.7 
9.0 
13.1 

4.7 
5.8 
12.1 
16.0 
11.1 
16.2 

4.0 
4.3 
9.7 
12.7 
9.1 
13.6 

2.2 
1.9 
3.3 
3.0 
1.7 
2.8 

1.8 
2.2 
2.9 
2.3 
2.4 
1.3 

1915  

1914  

1913  

1912  

1911  

It  is  not  necessary  to  comment  in  this  report,  at  length,  on  the 
greatly  decreased  and  almost  continuously  decreasing  mortality 
from  scarlet  fever  as  shown  both  by  the  experience  among  Metro- 
politan Industrial  policyholders  and  by  the  reports  of  the  Bureau 
of  the  Census  since  the  year  1900.  Inasmuch  as  the  mortality 
from  this  disease  is  of  such  great  interest  from  a  public  health 
standpoint,  one  cannot  fail  to  be  impressed  by  the  great  saving  of 
life  which  these  reports  show — especially  when  we  examine  the 
annual  Census  mortality  volumes  beginning  with  the  year  1900. 
Special  emphasis  should  be  laid  on  this  point:  great  as  is  the  de- 
crease in  the  mortality  as  indicated  by  the  published  death  rates  for 
the  Registration  Area,  there  has  been  a  still  greater  actual  decrease. 
The  published  death  rates  for  scarlet  fever  have  been  materially 
increased  by  the  educational  work  of  public  and  corporate  registra- 
tion offices  in  securing  increased  precision  of  statement  of  causes 
of  death. 

In  a  recent  study  of  the  mortality  of  childhood,*  it  was  shown 
that  scarlet  fever,  while  unimportant  as  a  cause  of  death  in  the 

*  "The  Mortality  of  Childhood,"  Dublin,  Louis  I.  Bead  at  the  Seventy- 
ninth  Annual  Meeting  of  the  American  Statistical  Association,  Philadelphia, 
December  27,  1917.  Published  in  Quarterly  Publications  of  the  American 
Statistical  Association,  March,  1918. 


186         MORTALITY    STATISTICS  OP   INSURED   WAGE   EARNERS. 


first  year  of  life  caused  1.7  per  cent,  of  all  the  deaths  between  one 
and  two  years  of  age  in  the  Registration  Area  during  the  period 
1910  to  1915;  4.7  per  cent,  between  two  and  three  years;  7.0  per 
cent,  between  three  and  four  years  and  7.6  per  cent,  during  the 
fifth  year  of  life.  During  the  second  quinquennium  7.1  per  cent, 
of  all  of  the  deaths  were  ascribed  to  scarlet  fever.  This  percent- 
age dropped  to  3.0  during  the  third  quinquennium. 

(c)  WHOOPING  COUGH. 

Like  measles,  whooping  cough  is  seldom  fatal  when  uncom- 
plicated. When  whooping  cough  causes  death  it  is  usually  through 
terminal  pulmonary  conditions,  bronchopneumonia  in  particular. 
Because  of  its  very  wide  prevalence  it  is,  like  measles  again,  a  very 
dangerous  disease  and  one  which  stands  high  among  the  fatal 
affections  of  children.  In  all,  3,075  deaths  were  caused  by  whoop- 
ing cough  among  policyholders  during  the  period  1911  to  1916, 
corresponding  to  a  rate  of  5.7  per  100,000  exposed  at  all  ages. 

The  disease  is  limited  almost  entirely  to  the  ages  of  childhood. 
Of  all  the  deaths,  98.2  per  cent,  occurred  among  children  between 
one  and  nine  years  old,  and  86.7  per  cent,  of  the  decedents  were 
between  one  and  four  years  of  age.  There  is,  therefore,  very  little 
room  for  a  discussion  of  whooping  cough  mortality  by  age  period 
apart  from  the  first  two  quinquennia  of  life.  The  following  table 
shows  the  facts  for  the  ages  under  10  years  for  each  color  and  sex 

group : 

TABLE  114. 

MORTALITY  PROM  WHOOPING  COUGH,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death   Rates  per   100,000  Persons  Exposed.     1911    to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

white. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

5.7 

4.7 

5.6 

9.2 

9.3 

1  to  4   .    ... 

59.1 
4.9 
.1 

42.0 
3.0 
.1 

60.9 

4:? 

151.3 
12.7 
.2 

173.9 
17.3 

.4 

5  to  9  

10  and  over  .  . 

PRINCIPAL  COMMUNICABLE  DISEASES  OP   CHILDHOOD.          187 


Unlike  the  other  communicable  diseases  of  children  the  death 
rate  for  whooping  cough  is  considerably  higher  among  colored  than 
among  white  children.  In  fact  in  the  age  period  of  1  to  4  years, 
the  mortality  from  whooping  cough  among  colored  boys  and  girls 
is  approximately  three  times  as  high  as  among  white  children 
of  the  same  ages.  The  disease  is  also  more  prevalent  among 
females  than  among  males.  This  is  true  for  each  of  the  significant 
age  periods  and  for  each  race.  Similar  relations  are  found  to 
exist  in  the  data  for  the  population  of  the  Eegistration  Area.  The 
following  table  which  is  limited  to  the  significant  age  periods  will 
serve  as  a  basis  for  comparison  of  the  mortality  from  this  disease 
in  the  two  experiences: 

TABLE  115. 

MORTALITY  FROM  WHOOPING  COUGH. 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  "by  Age 
Period.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  Begistra- 
tion  Area  of  the  United  States  (1910  to  1915). 


Age  Period. 

Males. 

Females. 

M.L.I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.L.I.  Co. 
of  Reg.  Area. 

M.L.I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.L.  I.  Co. 
of  Reg.  Area. 

1  to  4  
5  to  9  
10  and  over. 

42.0 
3.0 
.1 

40.0 
3.2 
.1 

105.0 
93.8 
100.0 

60.9 
4.9 
.1 

55.6 
4.6 
.2 

109.5 
106.5 
50.0 

In  all  comparisons  between  the  mortality  experience  of  Metro- 
politan Industrial  policyholders  and  of  the  expanding  Registration 
Area,  for  whooping  cough,  we  should  not  lose  sight  of  the  fact  that 
of  the  four  chief  epidemic  diseases  known  as  "  children's  diseases/' 
namely,  measles,  scarlet  fever,  diphtheria  and  whooping  cough,  the 
last  named  is  the  only  one  for  which  the  mortality  is  higher  in 
rural  than  in  urban  districts.  The  fact  that  the  rural  population 
in  the  Registration  Area  is  large  and  that  among  the  Industrial 
policyholders  of  the  Company  it  is  small,  must,  therefore,  always 
be  considered  in  comparing  the  two  experiences. 

The  trend  of  whooping  cough  mortality  has  been  downward  since 
1911.  The  variations  in  the  rate  from  year  to  year  are  largely 
accounted  for  by  the  epidemic  character  of  the  disease.  The  rate 
for  1916,  for  example,  rose  very  appreciably  over  that  for  1915  but 


188         MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


is  nevertheless  much  lower  than  the  rate  for  1911.  The  trend 
corresponds  closely  with  that  in  the  expanding  Registration  Area, 
but  for  both  experiences  it  may  safely  be  said  that  a  large  measure 
of  mortality,  entirely  unnecessary  and  subject  to  ready  control, 
would  be  eliminated  if  the  necessary  steps  were  taken  to  impress 
upon  the  public  the  truly  dangerous  character  of  the  disease  and  to 
prevent  children  from  coming  in  contact  with  those  afflicted.  The 
following  table  shows  the  figures  for  whooping  cough  for  each  of 
the  six  years: 

TABLE  116. 

MORTALITY  FROM  WHOOPING  COUGH,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.     Single  Tears  in  Period  1911 

to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

5.7 

4.7 

5.6 

9.2 

9.3 

1916    

5.8 
4.7 
5.8 
5.9 
5.1 
7.1 

4.9 
4.3 
4.7 
4.5 
4.3 
5.5 

6.3 
4.6 
5.6 
5.8 
4.9 
6.8 

7.3 
6.8 
10.0 
10.5 
7.9 
13.3 

6.5 
6.6 
10.6 
11.1 
8.3 
13.5 

1915  

1914  

1913  

1912  

1911  

As  with  all  epidemic  diseases  there  is,  among  physicians,  a  tend- 
ency in  fatal  cases  to  report  on  death  certificates  the  terminal  com- 
plication to  the  exclusion  of  the  primary  cause.  The  fact  that  the 
profession  has  been  less  prone  to  do  this  in  later  years  than  in 
earlier  ones  affects  very  materially  the  comparability  of  a  series 
of  death  rates  for  whooping  cough  extending  over  a  long  period  of 
years  Unless  the  compiling  offices,  which  publish  figures  for 
different  areas,  have  been  equally  assiduous  in  their  efforts  to 
correct  these  careless  statements  of  cause  of  death,  the  compara- 
bility of  one  set  of  death  rates  with  another  is  extremely  question- 
able. When  allowance  is  made  for  this  factor,  it  is  evident  that 
there  has  been  a  considerable  decrease  in  the  mortality  in  the  ex- 
panding Registration  Area  of  the  United  States  since  1900, 
although  the  published  figures  themselves,  if  not  competently  and 
critically  analyzed,  do  not  indicate  this.  Thus,  the  published 
annual  average  death  rate  in  the  expanding  Registration  Area  for 


PRINCIPAL   COMMUNICABLE  DISEASES   OF   CHILDHOOD. 


189 


the  period  1901  to  1905  was  10.9  per  100,000  population,  which  is 
but  little  higher  than  the  10.2  in  that  area  for  the  year  1916. 
There  has  been,  however,  as  a  matter  of  fact,  a  greater  decrease  in 
the  actual  mortality  from  whooping  cough  than  these  figures  indi- 
cate, because  the  earlier  compilations  are  not  based  on  so  high  a 
proportion  of  accurate  statements  of  the  primary  cause  of  death 
as  are*  the  later  ones. 

(d)  DIPHTHERIA  AND  CROUP. 

The  deaths  included  under  this  title  are  very  nearly  all  certified 
in  modern  practice  as  due  to  "diphtheria."  The  former  usage  of 
the  words  "croup"  and  "membranous  croup"  as  synonyms  for 
diphtheria  is  no  longer  current.  It  is  believed  that  the  statistics  on 
diphtheria  in  this  report  are  especially  accurate,  first,  because  of 
the  characteristic  and,  for  the  most  part,  unmistakable  clinical 
picture  in  fatal  diphtheria  and,  second,  because  of  the  care  taken 
in  this  office  to  secure  as  accurate  a  statement  of  the  cause  of  death 
from  the  physician  as  possible. 

TABLE  117. 
MORTALITY  FROM  DIPHTHERIA  AND  CROUP,  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AGE  PERIOD. 

Death   Bates  per  100,000  Persons  Exposed.    1911   to   1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

24.3 

29.8 

23.8 

9.6 

8.6 

1  to  4  

152.2 
66.1 
13.8 
3.0 
1.6 
1.3 
.9 
.8 

165.3 
68.1 
12.6 
3.0 
1.5 
.8 
1.0 
.7 

149.2 
70.0 
16.0 
3.1 
1.5 
1.5 
.9 
.8 

90.4 
31.8 
8.2 
2.2 
2.3 
.7 
1.0 
.7 

75.5 
35.2 
10.3 
3.2 
1.6 
2.3 
1.0 
1.1 

5  to  9   

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  and  over.  . 

Diphtheria  begins  to  assume  importance  as  a  cause  of  death  in 
the  second  year  of  life.  In  the  third  year  of  life,  between  two  and 
three  years  of  age,  it  is  the  third  cause  of  death  in  numerical  im- 
portance. Between  three  and  four  years,  between  four  and  five 


190 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


years  and  in  the  age  period  five  to  nine  years,  diphtheria  is  the 
first  cause  of  death  in  order  of  numerical  significance.  In  the 
five  year  age  period  ten  to  fourteen  years,  this  disease  constitutes 
the  third  cause  of  death  in  numerical  rank.  There  is  an  appre- 
ciable death  rate  from  the  disease  at  the  various  ages  in  adult  life. 
The  age  statistics  for  the  disease  are  given  in  the  table  on  page  189. 
As  was  the  case  for  scarlet  fever  and  measles,  both  colored  males 
and  females  show  very  much  lower  death  rates  for  diphtheria  than 
do  white  males  and  females.  Between  one  and  four  years  of  ajre, 
the  death  rate  of  females  from  diphtheria  is  lower  than  that  for 
males  among  both  the  white  and  colored  race  groups  in  this  experi- 
ence. Beginning  with  the  age  period  five  to  nine  years,  however, 
and  up  to  twenty  years  of  age  the  mortality  for  females  from  diph- 
theria is  significantly  higher  than  for  males.  This  applies  to  both 
the  white  and  colored  groups. 

Death  Rate  from  Diphtheria  among  Insured  Children  of  White 

Wage  Earners  and  among  Children  in  the  Population  of  the 

Expanding  Registration  Area  Compared. 

At  the  ages  under  15  years,  the  diphtheria  death  rates  of  both 
male  and  female  children  of  insured  wage  earners  are  higher  than 


TABLE  118. 
MORTALITY  PROM  DIPHTHERIA  AND  CROUP. 

Death  Bates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Period.     Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  Experience  of  Expanding  'Registra- 
tion Area  of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.  L.I.  Co. 
of  Reg.  Area. 

All  ages  —  one 
and  over  

29.8 

17.2 

288.8 

23.8 

17.3 

137.6 

1  to  4...   . 
5  to  9...   . 
10  to  14.  .   . 
15  to  19.  .   . 
20  to  24..   . 

165.3 
68.1 
12.6 
3.0 
1.5 

127.3 
48.7 
11.4 
3.4 
1.7 

129.9 
139.8 
110.5 
88.2 
88.2 

149.2 
70.0 
16.0 
3.1 
1.5 

113.8 
51.8 
13.1 
3.7 
2.2 

131.1 
135.1 
122.1 
83.8 
68.2 

PRINCIPAL   COMMUNICABLE   DISEASES   OF    CHILDHOOD. 


191 


the  corresponding  rates  among  children  in  the  expanding  Regis- 
tration Area  of  the  United  States.  Between  one  and  four  years 
the  excess  amounted  to  practically  30  per  cent.,  and  between  five 
and  nine  years,  to  practically  40  per  cent,  for  insured  males,  and  to 
35  per  cent,  for  females.  The  table  on  page  190  gives  a  compari- 
son of  the  chief  facts  of  diphtheria  mortality  at  the  ages  under  25 
years  for  both  the  insurance  and  the  population  experience. 

Trend  of  the  Death  Rate  for  Diphtheria* 

Barring  two  years  in  this  experience,  1911  and  1913,  there  has 
been  a  slightly  downward  general  tendency  of  the  death  rate  from 
diphtheria.  This  corresponds  fairly  well  to  the  tendency  observed 
in  the  experience  of  the  expanding  Registration  Area  of  the  United 
States.  The  various  methods  employed  in  the  control  of  diph- 
theritic infection  and  in  the  reduction  of  case  mortality  have  been 
productive  of  results  in  those  countries  which  have  fairly  well 

TABLE  119. 

MORTALITY  FROM  DIPHTHERIA  AND  CROUP,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Eates  per  100,000  Persons  Exposed.     Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

24.3 

29.8 

23.8 

9.6 

8.6 

1916.. 

21.0 
21.4 
25.7 
27.2 
24.5 
27.3 

25.4 
26.3 
30.8 
33.3 
30.5 
34.0 

20.4 
20.7 
25.8 
26.7 
23.5 
26.6 

8.5 
8.5 
7.1 
11.7 
11.2 
10.7 

7.8 
8.4 
10.6 
8.8 
7.8 
7.9 

1915  

1914  

1913  

1912  

1911  

organized  systems  of  preventive  medicine.  In  the  United  States. 
for  instance,  the  death  rate  of  the  Registration  Area  was  43.3  per 
100,000  persons  in  1900,  and  15.7  in  1915,  the  latter  rate  being 
the  lowest  recorded  in  any  of  the  years  since  1900.  It  may  be  ex- 
pected that  from  time  to  time  epidemics  of  this  disease  will  serve 
to  raise  the  rate  somewhat,  but,  in  the  long  run,  the  various  pre- 
ventive measures  employed,  especially  the  administration  of  diph- 


192          MORTALITY    STATISTICS  OF  INSURED   WAGE  EARNERS. 

theria  antitoxin,  the  extension  of  school  medical  inspection,  the 
effective  quarantine  of  cases  and  the  detection  of  atypical  carriers, 
may  be  depended  upon  to  still  further  reduce  mortality  from  this 
cause. 

The  table  on  page  191  gives  the  facts  for  each  calendar  year,  1911 
to  1916,  in  this  experience. 


CHAPTER  XII. 
DIARRHEA  AND  ENTERITIS. 

The  data  for  diarrhea  and  enteritis  presented  in  this  report  do 
not  distinguish  between  infantile  diarrhea  as  classified  under  Title 
No.  104  of  the  International  List,  and  diarrhea  and  enteritis 
(affecting  persons  two  years  of  age  and  over)  as  compiled  under 
Title  No.  105.  The  largest  proportion  of  the  deaths  from  infantile 
diarrhea  and  enteritis  occurs  in  the  general  population  under  one 
year  of  age.  Since  no  persons  under  one  year  of  age  are  included 
in  this  insurance  experience,  a  distinction  in  our  figures  of  the 
type  of  diarrhea  would  affect  only  those  deaths  between  ages  one 
and  two.  These  have  no  great  significance.  This  accounts  for  the 
decision  to  combine  the  two  titles.  There  were  included  under  the 
title,  thus  understood,  all  forms  of  inflammatory,  ulcerative  or 
catarrhal  conditions  of  the  intestines  or  of  the  gastroenteric  tract 
where  the  intestines  were  chiefly  involved,  except  those  definitely 
reported  as  due  to  tuberculous,  cancerous,  dysenteric  or  other 
primary  factors. 

It  should  be  remembered  that  this  cause  of  death  may  be  either 
primary  or  secondary.  Only  the  presumably  primary  cases  are 
listed  in  this  experience,  and  these  cases  result,  especially  among 
children,  from  the  use  of  improper  food,  from  various  toxic  sub- 
stances produced  in  the  decomposition  of  food,  from  the  extreme 
heat  of  summer ;  or,  as  in  senility,  from  changes  in  the  constitution 
of  intestinal  secretions.  These  constitute  the  larger  proportion 
of  the  cases  in  the  insurance  experience.  The  secondary  cases  of 
diarrhea  and  enteritis  follow  certain  infectious  diseases  such  as  true 
dysentery  and  typhoid  fever;  they  also  follow  circulatory  disturb- 
ances which  cause  a  catarrhal  enteritis  of  chronic  character,  and 
they  are  common  in  diseases  of  the  liver  and  in  chronic  conditions 
of  the  heart  and  lungs,  as  well  as  in  cachectic  conditions  such  as 
cancer,  pernicious  anemia  and  Bright's  disease.  None  of  the  above 
is  included  in  the  present  discussion. 

The  total  number  of  deaths  assigned  to  the  combined  title  during 
the  period  between  1911  and  1916  was  14,173.  These  deaths  ac- 
14  193 


194 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


counted  for  2.2  per  cent,  of  the  entire  mortality  and  corresponded 
to  a  rate  of  26.3  per  100,000.  The  rates  according  to  color,  sex 
and  age  are  shown  in  the  following  table : 

TABLE  120. 

MORTALITY  FROM  DIARRHEA  AND  ENTERITIS,  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AOE  PERIOD. 

Death  Eates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Male*. 

Female*. 

Males. 

Females. 

All  ages  —  one  and 
over  

26.3 

28.2 

24.6 

26.4 

27.7 

1  to  4  

208.7 
8.8 
2.4 
1.9 
2.8 
4.5 
7.7 
10.9 
28.2 
80.3 
182.5 

210.6 
8.2 
2.1 
1.2 
1.8 
4.4 
8.0 
10.1 
25.6 
63.8 
180.2 

197.1 
8.4 
2.0 
1.4 
2.9 
3.6 
5.7 
8.9 
25.1 
86.8 
183.3 

298.0 
10.1 
3.8 
7.0 
3.6 
5.9 
10.8 
14.7 
43.2 
76.8 
150.9 

249.4 
16.9 
6.8 
6.7 
6.3 
8.7 
14.5 
24.3 
51.9 
117.4 
208.7 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

The  highest  death  rates  in  this  experience  are  recorded  in  the 
first  and  last  age  periods,  namely,  1  to  4  years  and  over  75  years. 
The  minimum  rate  is  in  the  period  15  to  19  years  among  the  whites 
and  in  the  period  20  to  24  years  among  the  colored.  There  is  con- 
siderable variability  in  the  rates  for  the  colored  race  by  age  period. 
From  the  minimum  at  20  to  24  years  the  rates  rise  regularly  and, 
after  age  45  is  reached,  very  rapidly,  to  their  maximum  in  advanced 
old  age.  The  period  65  to  74  years  is  an  important  one  from  the 
point  of  view  of  mortality  from  diarrhea  and  enteritis. 

Colored  persons,  especially  when  considered  for  specific  age 
periods,  show  higher  rates  than  do  white  persons.  The  single  ex- 
ception is  for  males  75  years  and  over.  It  is  quite  possible  that 
even  this  exception  would  be  eliminated  if  the  figures  for  colored 
males  75  and  over  were  based  on  a  larger  experience.  A  feature 
of  the  colored  experience  is  the  maintenance  of  a  comparatively 
high  rate  in  the  period  of  early  adult  life  when  the  very  lowest 
figures  prevail  for  the  whites.  Thus,  in  the  period  between  15  to 


DIARRHEA   AND   ENTERITIS. 


195 


19  years,  the  rate  for  colored  lives  is  more  than  four  times  as  high 
as  for  white  lives. 

The  ratios  of  the  death  rates  of  the  sexes  vary  for  the  two  races. 
Among  insured  white  lives  the  total  rate  is  higher  for  males  than 
for  females  but  this  is  due  principally  to  the  higher  mortality  in  the 
period  of  early  childhood.  In  the  period  of  old  age  the  rates  are 
higher  for  females.  Colored  females  have  higher  rates  than  the 
males  virtually  throughout  life  with  the  exception  of  the  period 
under  five  years.  The  excess  in  the  rate  of  females  is  especially 
marked  in  the  ages  after  65  years. 

Comparison  of  Mortality  from  Diarrhea  and  Enteritis  among  In- 
sured Wage  Earners  and  among  the  General  Population  of 
the  Expanding  Registration  Area. 

At  the  important  age  periods,  that  is,  under  5  years  and  at  75 
years  and  over,  insured  lives  show  lower  death  rates  from  these 
causes  than  are  found  in  the  population  of  the  Registration  Area 
of  the  United  States.  The  single  exception  is  found  among  the 
males  75  and  over,  but  even  there  the  difference  is  not  marked.  At 

TABLE  121. 

MORTALITY  FROM  DIARRHEA  AND  ENTERITIS. 

Death  Bates  per  100,000  Persons  Exposed.    Classified  by  Sex  and  by  Age 

Periods.    Insured  White  Lives  in  Experience  of  Metropolitan  Life 

Insurance  Company,  Industrial  Department   (1911   to  1916) 

and  General  Population  of  Expanding  Registration  Area 

of  the  United  States  (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  S.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

28,2 

28.0 

100.7 

24.6 

28.9 

85.1 

Ito4... 

210.6 

232.3 

90.7 

197.1 

210.0 

93.9 

5  to  9... 

8.2 

8.0 

102.5 

8.4 

8.0 

105.0 

10  to  14.  . 

2.1 

2.2 

95.5 

2.0 

1.9 

105.3 

15  to  19.. 

1.2 

1.5 

80.0 

1.4 

1.7 

82.4 

20  to  24.. 

1.8 

1.9 

94.7 

2.9 

2.9 

100.0 

25  to  34.  . 

4.4 

3.2 

137.5 

3.6 

3.6 

100.0 

35  to  44.  . 

8.0 

5.4 

148.1 

5.7 

5.6 

101.8 

45  to  54.  . 

10.1 

9.1 

111.0 

8.9 

9.9 

89.9 

55  to  64.  . 

25.6 

19.2 

133.3 

25.1 

22.9 

109.6 

65  to  74.. 

63.8 

48.8 

130.7 

86.8 

63.9 

135.8 

75  and  over 

180.2 

173.6 

103.8 

183.3 

223.3 

82.1 

196 


MORTALITY    STATISTICS   OP   INSURED   WAGE   EARNERS. 


the  age  periods  beyond  25  years  there  is,  generally  speaking,  an  ex- 
cess among  the  insured  over  the  general  population,  which  is  marked 
in  the  ages  after  35  years  among  males.  For.  the  females  the  two 
sets  of  figures  are  not  very  different.  When  the  urban  character  of 
the  insured  industrial  population  is  considered  with  the  fact  that 
death  rates  from  diarrhea  and  enteritis  are  uniformly  higher  in  such 
areas  than  in  rural  communities,  the  generally  favorable  conditions 
found  to  prevail  in  the  insurance  experience  at  the  youngest  ages 
are  even  more  remarkable.  The  table  on  page  195  exhibits  the 
figures  for  the  two  groups. 

Trend  of  the  Death  Rate  from  Diarrhea  and  Enteritis. 

In  general  there  has  been  a  reduction  in  the  death  rate  from  this 
condition  during  the  six  year  period  but  it  has  not  been  marked. 
There  was  hardly  any  change  in  the  rate  during  the  first  three  years ; 
a  reduction  then  occurred  for  the  next  two  years  and  in  1916  an 
increase  was  registered.  The  rate  in  that  year  was  not  as  high  as 
during  the  first  three  years  of  experience  in  the  present  series.  The 
reduction  is  much  more  consistent  and  noteworthy  among  colored 
males  and  females  than  among  white.  A  similar  tendency  is  ob- 
servable in  the  figures  for  the  expanding  Registration  Area  but 
before  any  detailed  comparisons  can  be  made  it  must  be  remembered 
that  the  insurance  figures  do  not  include  infants  under  one.  The 
following  table  presents  the  figures  for  the  trend  of  the  death  rate 
from  diarrhea  and  enteritis  among  the  insured  wage  earners: 

TABLE  122. 

MORTALITY  FROM  DIARRHEA  AND  ENTERITIS,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.  Single  fears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

26.3 

28.2 

24.6 

26.4 

27.7 

1916... 

26.3 
24.4 
24.8 
27.7 
27.6 
27.9 

28.7 
26.3 
26.7 
29.9 
28.7 
29.2 

24.9 
22.5 
23.1 
26.0 
25.3 
26.4 

22.2 
25.6 
24.7 
26.2 
32.3 
28.0 

24.3 
25.4 
25.4 
28.3 
32.5 
31.0 

1915  

1&14  

1913  

1912  

1911  

CHAPTER  XIII. 
DISEASES  AND  CONDITIONS  INCIDENTAL  TO  THE  MATERNAL  STATE. 

A  study  of  the  mortality  of  women  from  the  causes  and  condi- 
tions incidental  to  childbearing  is  of  singular  interest  and  import- 
ance at  the  present  time  in  view  of  the  nation-wide  campaign  for 
the  conservation  of  civilian  life  during  wartime.  Deaths  of  women 
from  these  causes  affect  the  community  deeply  because  they  are  for 
the  most  part  preventable,  and  because  they  occur  at  periods  of  life 
when  each  death  involves  serious  social  loss.  The  amount  of  such 
loss  is  very  considerable.  Between  the  ages  of  15  and  45  years,  the 
diseases  and  conditions  incidental  to  child-bearing  account  for  more 
deaths  of  women  than  does  any  other  disease  or  class  of  diseases 
except  tuberculosis.  An  examination  of  the  available  facts  on 
maternal  mortality  should,  therefore,  assist  materially  in  directing 
the  plans  which  may  be  developed  to  control  these  causes  of  prevent- 
able death,  distress  and  family  disintegration. 

The  statistical  study  of  these  causes  of  death  may  be  undertaken 
in  a  number  of  different  ways.  The  first  and  usual  method  is  to 
consider  these  diseases  and  conditions  in  a  manner  similar  to  other 
causes  of  death;  namely,  to  relate  the  deaths  to  the  total  popula- 
tion. The  rates  obtained  in  this  way  serve  to  indicate  the  proper 
place  of  puerperal  mortality  among  the  several  important  conditions 
causing  death  in  the  whole  population.  Such  mortality  rates  are, 
however,  limited  in  their  utility ;  for  the  deaths  are  of  females  alone, 
while  the  total  population  contains  both  males  and  females. 
Another  method  often  used,  is  to  relate  the  puerperal  deaths  to  the 
total  number  of  females  in  the  community.  This  gives  another  and 
higher  rate  than  the  one  noted  above.  The  figure  thus  obtained  has 
this  limitation:  the  population  refers  to  all  females,  whereas  the 
deaths  are  those  of  women  within  a  limited  range  of  ages.  We 
have,  therefore,  in  our  treatment  followed  a  third  method  and  have 
presented  specific  death  rates  which  are  limited  to  females  of  the 
childbearing  ages,  namely,  15  to  44  years.  In  every  case  we  have 
attempted  to  give  the  facts  for  five  and  ten  year  age  groups  during 
this  puerperal  period.  The  rates  are,  therefore,  based  on  deaths 

197 


198         MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 


and  on  exposed  lives  homogeneous  with  respect  to  sex  and  age.    A 
very  sensitive  measure  of  puerperal  mortality  is  thus  obtained. 

In  this  investigation  there  were  recorded  in  all  10,056  deaths 
from  the  diseases  and  conditions  incidental  to  childbirth  in  the  age 
period  15  to  44  years.  This  covers  the  six-year  period  from  1911 
to  1916  inclusive.  These  deaths,  when  related  to  the  14,694,260 
years  of  life  exposed  of  women  15  to  44  years  of  age,  correspond  to 
a  death  rate  of  68.4  per  100,000  women  at  these  ages.  Of  the  total 
deaths,  8,288  occurred  among  white  females  and  1,768  among 
colored  females ;  the  rates  per  100,000  for  the  two  races  being  66.1 
and  82.3  for  the  white  and  colored  women  respectively.  It  is,  thus, 
shown  at  the  outset  that  colored  females  suffer  much  more  seriously 
than  do  white  women  from  the  diseases  and  conditions  incidental  to 
childbearing. 

TABLE  123. 

MORTALITY  FROM  PUERPERAL  DISEASES  AND   CONDITIONS.    CLASSIFIED   BY 
COLOR.    DEATHS  IN  AGE  PERIOD  15  TO  44  YEARS. 


Experience  of  Metropolitan  Life  Insurance  Company. 
ment,  1911  to  1916. 


Industrial  Depart- 


Puerperal  Disease  or 
Condition. 

White  and  Colored. 

White. 

Colored. 

Deaths. 

fe|l 
*|S 

ffei 
•" 

1 
I 

-3  • 

1  4 

! 

$ 

it] 

Total  puerperal  dis- 
eases and  con- 
ditions   

10,056 

100.0 

68.4 

8,288 

100.0 

66.1 

1,768 

100.0 

82.3 

Accidents  of 
pregnancy  
Puerperal 
hemorrhage.  .  . 
Other  accidents 
of  labor  

874 
779 
1,020 
4,321 

2,654 
408 

8.7 
7.7 
10.1 
43.0 

26.4 
4.1 

5.9 
5.3 
6.9 
29.4 

18.1 
2.8 

704 
670 

827 
3,494 

2,233 
360 

8.5 
8.1 
10.0 
42.2 

26.9 
4.3 

5.6 

5.3 
6.6 
27.9 

17.8 
2.9 

170 
109 
193 

827 

421 
48 

9.6 
6.2 
10.9 
46.8 

23.8 
2.7 

7.9 
5.1 
9.0 
38.5 

19.6 
2.2 

Puerperal 
septicemia.  .  .  . 
Puerperal  albu- 
minuria  and 
convulsions.  .  .  . 
Other  puerperal 
diseases  and 
conditions  

The  10,056  deaths  were  due  to  a  considerable  number  of  diseases 
and  conditions  complicating  or  characteristic  of  the  puerperal  state. 
The  most  important  of  these  is  septicemia,  which  alone  was  respon- 


DISEASES   INCIDENTAL   TO    MATERNAL   STATE.  199 

sible  for  4,321  deaths,  or  43.0  per  cent,  of  the  total.  This  condition 
was  followed  in  order,  by  albuminuria  and  convulsions  with  2,654 
deaths,  or  26.4  per  cent,  of  the  total.  Together,  these  two  definite 
conditions  account  for  69.4  per  cent,  of  the  fatal  puerperal  cases, 
but  it  is  realized  that  the  actual  proportion  is  even  higher.  Many 
deaths  from  puerperal  septicemia  and  puerperal  albuminuria  are, 
unfortunately,  still  reported  under  the  disguise  of  one  or  another 
of  these  terms,  without  qualification,  which  results  in  their  assign- 
ment to  conditions  which  are  not  classified  under  the  puerperal 
total. 

The  table  on  page  198  shows  the  number  and  percentage  of  deaths 
as  well  as  the  rates  per  100,000  exposed  from  the  several  conditions 
incidental  to  childbirth ;  distinction  is  made  as  to  the  color  or  race 
of  the  decedents. 

It  would  be  interesting  to  classify  these  deaths  according  to  the 
period  of  their  occurrence,  that  is,  whether  during  pregnancy,  at 
confinement  or  during  the  puerperium.  Unfortunately,  present 
methods  of  certification  and  classification  of  these  diseases  make  it 
impossible  to  draw  such  distinctions.  To  be  sure  the  accidents  of 
pregnancy  occur  in  the  antepartum  period.  The  deaths  from  puer- 
peral hemorrhage  and  from  "  other  accidents  of  labor "  are  clearly 
associated  with  labor.  On  the  other  hand,  such  titles  as  puerperal 
septicemia  and'  puerperal  albuminuria  and  convulsions,  which  relate 
to  the  largest  number  of  deaths,  may  cover  all  three  periods  in  the 
puerperal  state.  Puerperal  septicemia  is  most  often  a  complication 
of  labor  and  of  the  postpartum  period,  although  a  considerable 
number  of  deaths  are  associated  with  pregnancy  as  complications  of 
abortion,  miscarriage,  etc.  Fatal  puerperal  albuminuria  and  con- 
vulsions occur  most  frequently  as  complications  of  labor,  less  fre- 
quently during  pregnancy  and  least  of  all  during  the  puerperium. 

Comparing  the  mortality  of  the  two  races,  we  find  but  few  excep- 
tions to  the  rule  that  the  death  rates  of  colored  women  are  con- 
siderably higher  than  those  of  white  women  for  each  of  the  diseases 
and  conditions  mentioned.  The  largest  disparity  between  the  two 
races  is  to  be  noted  for  septicemia  for  which  the  white  and  colored 
rates  are  27.9  and  38.5  per  100,000  respectively.  It  is  interesting 
to  observe  that  the  mortality  rate  for  puerperal  hemorrhage  is 
slightly  lower  for  colored  women  as  is  also  the  case  in  the  miscella- 
neous group  entitled  "other  puerperal  diseases  and  conditions." 
Even  for  these  conditions  the  figures  require  further  study  before 


200          MORTALITY   STATISTICS   OF   INSURED   WAGE  EARNERS. 

conclusions  can  be  drawn.  It  is  a  question,  if  our  figures  related 
back  to  the  total  number  of  pregnancies  rather  than  to  the  total 
number  of  women,  ages  15  to  44,  whether  the  rate  would  show  up  as 
favorably  for  colored  as  for  white  women. 

Age  Incidence  of  Principal  Causes  of  Maternal  Mortality. 

The  foregoing  observations  on  maternal  mortality  are  of  greater 
import  when  considered  according  to  the  principal  age  periods. 
Let  us  first  study  all  of  the  causes  of  maternal  mortality  taken 
together. 

TABLE  124. 

MORTALITY    FROM    PUERPERAL    DISEASES    AND    CONDITIONS.    WHITE    AND 

COLORED  FEMALES. 

Death  Eates  per  100,000  Women  Exposed,  Ages  15  to  44  Years,  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 

Department. 


Age  Period. 

White  Females. 

Colored  Females. 

All  ages  —  15  to  44  years  

66.1 

82.3 

15  to  19  

24.3 

93.4 

20  to  24  

72.1 

100.7 

25  to  34  

93.0 

88.3 

35  to  44  

62.2 

56.7 

Considering  white  women  alone,  the  least  death  rate  for  all  dis- 
eases and  conditions  incidental  to  childbirth  was  registered  in  the 
age  period  15  to  19  years,  namely  24.3  per  100,000.  The  rate 
rises  rapidly  to  a  maximum  of  93.0  in  the  age  period  25  to  34  years 
and  then  declines  to  62.2  for  the  ten  year  period  35  to  44  years. 
Among  colored  females,  however,  we  observed  markedly  different 
age  characteristics  of  maternal  mortality.  The  rate  of  mortality 
among  colored  females  between  15  and  19  years  was  93.4  per 
100,000,  the  same  rate,  practically,  as  was  observed  in  the  period  of 
maximum  incidence,  25  to  34  years,  among  white  females.  From 
this  high  and  damaging  rate  in  the  fourth  quinquennium  of  life,  the 
rate  of  maternal  mortality  among  colored  females  rises  to  a  figure 
of  more  than  100  per  100,000  exposed  between  20  and  24  years  and 
declines  to  a  rate  of  88.3  per  100,000  exposed  in  the  age  period  25 
to  34  years.  It  is  of  singular  interest  to  observe  that  whereas  the 
colored  female  rate  for  maternal  mortality  is  practically  four  times 
that  of  white  females  for  the  age  period  15  to  19  years  and  prac- 


DISEASES    INCIDENTAL   TO    MATERNAL   STATE.  201 

tically  one-third  greater  than  the  rate  of  white  females  between 
20  to  24  years,  for  the  ages  after  25  years  and  up  to  44  years,  the 
mortality  rates  of  colored  females  for  all  puerperal  diseases  and 
conditions  combined  are  significantly  lower  than  the  rates  for  white 
females. 

The  table  on  page  200  shows  the  death  rates  per  100,000  women 
exposed  in  each  of  the  color  groups  in  this  study,  according  to  age 
periods. 

These  data  suggest  rather  than  answer  inquiry.  They  call  for  a 
further  display  of  obstetrical  statistics  to  show  the  number  of  births 
to  white  and  colored  women  at  the  several  age  periods  of  life  and  in 
relation  to  these  data,  the  deaths  from  the  various  diseases  and 
conditions  associated  with  childbearing.  Is  the  high  death  rate 
from  puerperal  diseases  among  young  colored  females  due  primarily 
to  a  very  high  birthrate  or  to  improper  care  of  parturient  colored 
women  in  the  early  ages  of  adult  life?  Has  the  factor  of  ille- 
gitimacy had  an  effect  upon  the  high  mortality  of  colored  mothers  ? 
These  and  other  questions  could  be  readily  answered  by  a  further 
display  of  birth  and  mortality  data. 

PUERPERAL  SEPTICEMIA. 

We  may  now  consider  the  facts  for  each  of  the  principal  puerperal 
diseases  in  relation  to  age  period.  Puerperal  septicemia,  for  white 
women,  shows  its  highest  mortality  rate  between  25  and  34  years, 
and  its  least  rate  between  15  and  19  years.  Among  colored  women, 
there  is  an  almost  uniform  and  very  high  rate  between  15  and  24 
years  with  only  a  slight  decline  during  the  period  25  to  34  years. 
For  the  age  group  35  to  44  years,  the  rates  for  white  and  colored 
women  for  puerperal  septicemia  are  practically  the  same.  The 
outstanding  feature  of  mortality  from  puerperal  septicemia  there- 
fore is  the  gradually  rising  rate  among  white  females  to  the  maxi- 
mum in  the  age  period  25  to  34  years  and  the  very  high  and  prac- 
tically stationary  rate  for  colored  females  for  nearly  twenty  years 
of  life  between  the  ages  15  and  35.  In  the  age  period  15  to  19 
years,  puerperal  septicemia  shows  a  rate  very  nearly  four  and  a  half 
times  as  high  among  colored  as  among  white  women,  although  at  the 
older  ages  the  rates  for  the  two  races  approximate  each  other. 
These  facts  are  shown  in  Table  125  following: 


202 


MORTALITY    STATISTICS  OP   INSURED   WAGE   EARNERS. 


TABLE  125. 

MORTALITY  FROM  PUERPERAL  SEPTICEMIA.    WHITE  AND  COLORED  FEMALES. 
Death  Rates  per  100,000  Women  Exposed,  Ages  15  to  44  Years,  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

White  Female*!. 

Colored  Femalei. 

All  ages  —  15  to  44  years  

27.9 

38.5 

15  to  19.. 

10.7 

46.3 

20  to  24...  

32.8 

49.4 

25  to  34  

40.7 

42.5 

35  to  44  

21.9 

22.2 

PUERPERAL  ALBUMINURIA  AND  CONVULSIONS. 

A  somewhat  similar  relation  is  also  to  be  noted  with  reference 
to  the  facts  for  puerperal  albmninuria  and  convulsions,  under  which 
title-heading  deaths  from  puerperal  nephritis  and  puerperal  uremia 
are  also  counted.  Among  white  women,  the  rate  is  lowest  between 
the  ages  15  and  19.  The  rate  rises  rapidly  to  its  maximum,  22.6. 
This  remains  stationary  between  20  and  35  years  of  age.  Colored 
females  show  the  maximum  rate  in  the  first  age  period  under  obser- 
vation, 15  to  19  years,  namely,  36.9  per  100,000,  with  a  gradual 
decline  to  a  minimum  at  the  latest  age  period,  35  to  44  years,  13.0. 
It  should  be  noted  that,  in  the  age  period  15  to  19  years,  colored 
females  show  a  death  rate  for  this  cause  nearly  four  times  that  for 
white  females.  Table  126  gives  the  facts  for  puerperal  albuminuria 
and  convulsions: 

TABLE  126. 

MORTALITY  FROM  PUERPERAL  ALBUMINURIA  AND  CONVULSIONS.    WHITE  AND 
COLORED  FEMALES. 

Death  Rates  per  100,000  Women  Exposed,  Ages  15  to  44  Tears,  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 
Department. 


Age  Period. 

White  Females. 

Colored  Females 

All  ages  —  15  to  44  years  

178 

196 

15  to  19  

95 

369 

20  to  24  

22.6 

230 

25  to  34  

22.6 

157 

35  to  44  

14.9 

13.0 

DISEASES  INCIDENTAL  TO  MATERNAL  STATE.  203 

ACCIDENTS  OF  PREGNANCY. 

Many  conditions  are  included  under  this  head  the  more  impor- 
tant of  which  are  abortions,  accidental  and  self  induced,  premature 
birth,  and  extra  uterine  or  tubal  gestation.  The  death  rate  among 
white  women  is  comparatively  low  until  age  25  is  reached.  The 
maximum  rate,  8.7  per  100,000  is  found  in  the  age  period  25  to  34 
years.  The  rate  declines  appreciably  thereafter.  Among  colored 
women,  however,  it  is  uniformly  higher  at  every  age  than  among 
white  women  but  this  is  especially  marked  at  the  ages  under  25. 
Between  20  and  25  years  the  death  rate  (10.3)  is  more  than  twice 
the  white  rate.  The  figure  declines  somewhat  between  the  ages  25 
and  34  and  more  markedly  between  35  and  44  years. 

It  is  a  matter  of  some  interest  that  a  very  large  proportion  of 
these  fatal  cases  are  the  direct  result  of  attempts  at  abortion.  In 
spite  of  the  many  efforts  to  cloak  this  condition,  we  have  record  of 
67  such  fatal  cases  in  the  Industrial  mortality  experience  of  1917 
alone.  Many  more  cases  certainly  occurred  but  were  not  reported. 
The  facts  would  appear  to  indicate  a  wide  prevalence  of  this  dan- 
gerous and  criminal  practice.  Our  data  comparing  the  two  color 
or  race  classes  according  to  age  periods  are  shown  below : 

TABLE  127. 

MORTALITY  FROM  ACCIDENTS  OP  PREGNANCY.    WHITE  AND  COLORED  FEMALES. 
Death  Rates  per  100,000  Women  Exposed,  Ages  15  to  44  Years,  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

White  Females. 

Colored  Females. 

All  ages  —  15  to  44  years  

56 

79 

15  to  19.. 

1  3 

2  1 

20  to  24  

47 

10  3 

25  to  34  

8  7 

9  9 

35  to  44  

6.0 

7.0 

PUERPERAL  HEMORRHAGE. 

The  deaths  under  this  title  include  those  reported  from  placenta 
previa.  and  retained  membranes  provided  there  is  no  evidence  of 
septicemia  as  a  complication.  The  mortality  rate  is  least  at  the 
youngest  ages.  Among  white  women,  the  rate  reaches  its  maxi- 
mum at  the  oldest  ages,  i.  e.,  35  to  44  years,  when  it  is  8.1  per 


204         MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 

100,000.  Among  colored  women  the  highest  rate  is  found  between 
25  and  34  years.  It  is  an  interesting  fact  previously  observed  by 
obstetricians  that  colored  women  at  the  older  ages  of  the  child- 
bearing  period  suffer  from  puerperal  hemorrhage  much  less  fre- 
quently than  do  white  women.  Table  128  gives  the  facts  for  puer- 
peral hemorrhage: 

TABLE  128. 

MORTALITY  FROM  PUERPERAL  HEMORRHAGE.  WHITE  AND  COLORED  FEMALES. 
Death  Bates  per  100,000  Women  Exposed,  Ages  15  to  44  Tears,  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

White  Females. 

Colored  Females. 

All  ages  —  15  to  44  years  

5.3 

5.1 

15  to  19.. 

.8 

.9 

20  to  24  

3.3 

6.1 

25  to  34  

7.5 

6.4 

35  to  44  

8.1 

5.1 

Other  Accidents  of  Labor. 

This  title  covers  such  deaths  as  are  due  to  breech  presentation, 
Caesarian  section,  and  forceps  operations  and  those  attributed  to 
dystocia,  "  injury  at  birth  "  and  to  "  childbirth  "  or  "  confinement," 
with  no  further  description.  In  the  period  15  to  19  years,  the  first 
age  period  for  which  we  have  figures  for  these  causes,  among  colored 
females  the  rate  was  five  times  that  of  white  females,  the  figures 
being  6.7  and  1.4  per  100,000  living,  respectively.  Thereafter,  the 
rates  for  the  two  races  are  not  so  divergent;  in  fact,  after  age  2~> 
they  are  nearly  identical.  The  maximum  rate  among  white  women 
is  found  in  the  age  period  25  to  34  years  when  it  is  9.4  per  100,000 
and  the  maximum  among  colored  women  in  the  earlier  age  group 
20  to  24  years,  when  the  rate  is  10.8.  The  data  for  these  "other 
accidents  of  labor  "  are  displayed  in  Table  129  on  the  next  pasre. 

Comparison  of  Insurance  data,  1911  to  1916,  with  Population  Data, 

1910  to  1915. 

The  above  facts  relate  to  a  large  group  of  female  Industrial 
policyholders.  For  purposes  of  comparison  we  may  turn  profitably 
to  the  figures  for  women  in  the  expanding  Registration  Area  of 


DISEASES   INCIDENTAL   TO    MATERNAL   STATE.  205 

TABLE  129. 

MORTALITY  FROM  "OTHER  ACCIDENTS  OP  LABOR."    WHITE  AND  COLORS 

FEMALES. 

Death  Rates  per  100,000  Women  Exposed,  Ages  15  to  44  Years,  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

White  Females. 

Colored  Females. 

All  ages  —  15  to  44  years  

6.6 

9.0 

15  to  19.. 

1.4 

6.7 

20  to  24  

6.1 

10.8 

25  to  34  

9.4 

10.3 

35  to  44  

7.8 

7.3 

the  United  States.  This  is,  in  fact,  the  largest  group  in  the  gen- 
eral population  of  the  United  States  for  whom  death  rates  may  be 
prepared  from  the  published  data  now  available.  A  number  of 
limitations,  however,  should  be  pointed  out  which  interfere  some- 
what with  the  complete  comparability  of  the  data  for  insured  women 
with  those  for  the  general  population.  The  figures  for  the  expand- 
ing Registration  Area  cover  the  six-year  period,  1910  to  1915 ;  the 
Metropolitan  figures  are  for  the  six-year  period,  1911  to  1916.  The 
population  of  the  Registration  Area  includes  a  small  proportion  of 
colored  in  addition  to  the  white,  whereas  the  insurance  figures  are 
for  each  of  the  two  races  taken  separately.  For  the  comparison,  the 
figures  for  white  insured  women  alone  will  be  used.  There  are  also 
differences  in  the  geographical  areas  covered  by  the  two  groups. 
The  Registration  Area  still  excludes  most  of  the  southern  and  a 
number  of  western  states ;  the  Metropolitan  policyholders  are  repre- 
sented in  nearly  all  of  these  states.  It  is  clear  nevertheless  that 
these  several  differences  are  not  sufficiently  important  to  vitiate  the 
comparisons,  of  the  mortality  rates  which  we  shall  make. 

In  the  six-year  period  1910  to  1915,  there  were  57,012  puerperal 
deaths  recorded  among  women  in  the  Registration  Area,  ages  15  to 
44  years.  This  corresponded  to  a  death  rate  of  63.1  per  100,000 
exposed  at  these  ages.*  The  rate  is  therefore  somewhat  less  than 

*  The  aggregate  number  of  years  of  life  of  women  ages  15  to  44  in  the 
Registration  Area  exposed  during  the  six  year  period  1910  to  1915  inclusive 
was  estimated  at  90,301,312,  from  data  furnished  by  the  Bureau  of  the 
Census  and  by  the  Prudential  Insurance  Company  of  America. 


206          MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 

that  for  the  insured  women  which  was  66.1.  The  slight  excess  in 
the  rate  of  mortality  from  diseases  and  conditions  connected  with 
maternity  among  insured  women  should  not  be  interpreted  too 
closely  as  an  indication  of  worse  conditions  respecting  childbirth 
among  the  wage  earning  element  of  the  population,  in  view  of  the 
higher  birth  rate  which  prevails  among  the  policyholders  than 
among  the  population  at  large  and  for  other  reasons.  As  was  the 
case  among  the  insured  women,  the  most  important  single  items 
included  in  this  mortality  study  of  the  general  population  are 
puerperal  septicemia  and  puerperal  albuminuria;  the  former  being 
responsible  for  44.4  per  cent,  and  the  latter  for  23.9  per  cent,  of  all 
the  puerperal  deaths.  Together,  these  two  conditions  are  respon- 
sible for  68.3  per  cent,  of  the  puerperal  deaths ;  among  the  insured 
white  women  they  accounted  for  69.1  per  cent.  The  accidents  of 
pregnancy  occurred  in  9.3  per  cent,  of  the  cases;  among  insured 
white  women  they  occurred  in  8.5  per  cent.  The  similarity  in  the 
two  sets  of  figures  is  marked  indeed  and  serves  to  confirm  the  gen- 
eral reliability  of  the  returns  in  the  two  series. 

Comparative  Age  Characteristics  of  Maternal  Mortality. 

The  data  for  the  puerperal  diseases  and  conditions  in  the  two 
series  are  also  very  similar  when  studied  by  age  period.  Consider- 
ing first  all  the  puerperal  causes  combined,  we  find  that  the  death 
rates  reach  a  maximum  in  both  groups  in  the  age  period  25  to  34 
years.  The  mortality  among  insured  women  is  lower  between  ages 
15  to  19  years  by  10  per  cent.  In  the  age  group  20  to  24  years  and 
in  the  age  periods  thereafter  up  to  44  years  of  age,  maternal  mor- 
tality among  insured  white  women  is  from  five  to  ten  per  cent, 
higher  than  among  the  female  general  population. 

For  puerperal  septicemia,  the  figures  are  slightly  more  favorable 
for  the  insured  women.  Thus,  between  the  ages  15  to  19,  insured 
white  women  show  a  death  rate  from  puerperal  septicemia  which  is 
only  83  per  cent,  of  the  rate  among  women  in  the  general  popula- 
tion. In  the  period  20  to  24  years  the  advantage  in  favor  of  the 
insured  women  is  close  to  5  per  cent,  of  the  population  rate.  Be- 
tween 25  and  34  years,  the  rate  for  the  insured  women  shows  an  ex- 
cess of  nearly  7  per  cent.  In  the  last  period  35  to  44  years,  the 
death  rate  is  practically  the  same  for  the  two  groups. 

The  figures  for  puerperal  albuminuria  and  convulsions  are  differ- 
ent in  several  respects  from  those  for  puerperal  septicemia,  the  rates 


DISEASES   INCIDENTAL   TO    MATERNAL    STATE. 


207 


being  on  the  whole  more  favorable  for  the  women  in  the  general 
population  than  for  the  industrial  group.  Virtually  the  same  mor- 
tality rates  are  observed  in  the  two  experiences  at  ages  15  to  19 
years  but  thereafter,  mortality  of  the  insured  is  considerably  higher 
than  for  women  in  the  Registration  Area.  It  is  25  per  cent,  higher 
at  the  age  period  25  to  34. 

TABLE  130. 
MORTALITY  FROM  PUERPERAL  DISEASES  AND  CONDITIONS. 

Death   Sates   per   100,000    Women   Exposed.     Classified   by   Age   Periods 

between  15  and  44  Years.     Insured  White  Lives  in  Experience  of 

Metropolitan  Life  Insurance  Company,  Industrial  Department 

(1911  to  1916)  and  General  Population  of  Expanding 

Eegistration  Area  of  the   United  States   (1910 

to  1915). 


Age  Period. 

Total-Puerperal  State. 

Puerperal  Septlcemla. 

Puerperal  Albumlnuria. 

M.  L.  I. 
Co. 

(White). 

u.  s. 

Reg. 
Area. 

P.  C., 
M.  L.  I. 
Co.  Of 
Reg. 
Area. 

M.  L.  I. 
Co. 
(White). 

TT.  8. 
Reg. 
Area. 

P.  C.. 

M.  L.  I. 
Co.  of 
Reg. 
Area. 

M.  L.  I. 
Co. 

(White). 

Reg. 
Area. 

P.  C.. 

M.  L.  I. 
Co.  of 
Reg. 
Area. 

All  ages  —  15 
to  44  years  . 

15  to  19.. 
20  to  24... 
25  to  34... 
35  to  44... 

66.1 

63.1 

104.8 

27.9 

28.1 

99.3 

17.8 

15.1 

117.9 

24.3 
72.1 
93.0 
62.2 

27.0 
68.9 
84.2 
58.4 

90.0 
104.6 
110.5 
106.5 

10.7 
32.8 
40.7 
21.9 

12.9 
34.4 
38.1 
21.7 

82.9 
95.3 
106.8 
100.9 

9.5 
22.6 
22.6 
14.9 

9.6 
18.3 
18.1 
12.9 

99.0 
123.5 
124.9 
115.5 

Table  130  presents  the  essential  rates  for  the  two  series  by  age 
period  not  only  for  the  total  puerperal  state  but  also  for  the  two 
most  important  single  conditions  in  this  disease  group. 

The  rates  for  the  other  puerperal  conditions  are  comparatively 
low  in  both  groups  and  do  not  justify  any  extended  comparisons  be- 
tween the  insured  and  the  general  populations. 

Relative  Improvement  in  Maternal  Mortality  among  Insured  Women 
and  in  the  General  Population. 

If  the  composite  death  rate  among  insured  white  women  appears 
to  be  somewhat  higher  than  that  for  women  in  the  population  gen- 
erally it  should  also  be  noted  that  this  difference  is  being  progres- 
sively overcome.  Thus,  in  1911,  a  death  rate  of  70.1  per  100,000 
insured  white  females  ages  15  to  44  years  was  recorded  and  in  1916, 


208 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


a  rate  of  62.6  per  100,000.  This  represents  a  decline  of  10.7  per 
cent,  in  the  rate  of  maternal  mortality  in  the  insured  group.  When 
we  compare  the  1910  rate  among  females  in  the  general  population 
of  the  Registration  Area,  63.4,  with  the  1915  rate,  61.6,  we  find  a 
decline  of  only  2.8  per  cent,  in  maternal  mortality.  In  1911,  the 
rate  among  the  insured  women  was  9  per  cent,  in  excess  of  the 
population  rate;  in  1915,  this  excess  was  reduced  to  only  3  per  cent. 
A  comparison  of  the  two  series  of  rates  annually  from  1911  to  191 54 
the  latest  year  for  which  these  figures  are  available  at  this  time  for 
the  Registration  Area  by  age,  is  shown  in  the  following  table : 

TABLE  131. 
MORTALITY  FROM  PUERPERAL  DISEASES  AND  CONDITIONS. 

Death  Rates  per  100,000  Women  Exposed,  Ages  15  to  44   fears.     Single 
Years  in  Period  1911  to  1916. 

Experience  of  Metropolitan   Life   Insurance   Company,  Industrial   Depart- 
ment, and  of  Expanding  Registration  Area  of  the  United  States. 


Year. 

Females,  Ages  15  to  44  Years. 

Death  Rates  per  100,000  Women  Exposed. 

Ratio,  Insurance  to 
Population, 
Reg.  Area  Rates. 

Insured  White 
Women. 

Women  In  Popula- 
tion, Reg.  Area. 

1916.  . 

62.6 
63.3 
68.6 
70.5 
62.4 

70.1 

* 

* 

61.6 
64.4 
64.1 
60.7 
64.5 
63.4 

* 

1.03 
1.07 
1.10 
1.03 

1.09 

* 

1915  

1914  

1913  

1912  

1911  

1910  

*Data  unavailable. 

There  is,  therefore,  a  general  tendency  for  the  rate  of  total 
maternal  mortality  among  insured  white  females  to  approximate 
that  of  females  in  the  general  population. 

A  greater  relative  reduction  in  mortality  is  also  observed  for 
puerperal  septicemia  among  insured  white  females  than  among 
females  in  the  general  population.  Thus,  in  1911  among  insured 
white  females,  aged  15  to  44  years,  we  recorded  a  death  rate  from 
this  condition  of  30.6  per  100,000  and  in  1916  a  rate  of  25.3  per 
100,000.  This  represents  a  decline  of  17.3  per  cent.  In  the  ex- 
perience of  the  Registration  Area  there  was  a  decline  in  the  six 
years  between  1910  and  1915  from  29.2  to  25.4  per  100,000  or  13.0 


DISEASES   INCIDENTAL   TO    MATERNAL    STATE. 


209 


per  cent.  In  1915,  the  rate  of  mortality  from  puerperal  septicemia, 
the  chief  cause  of  death  of  women  in  the  maternal  state,  was  actually 
lower  among  insured  white  females  than  among  females  in  the  gen- 
eral population.  The  following  table  gives  the  chief  comparative 
facts  for  puerperal  septicemia  in  both  experiences : 

TABLE  132. 

MORTALITY  FROM  PUERPERAL  SEPTICEMIA. 

Death  Rates  per  100,000  Women  Exposed,  Ages  15  to  44  Tears.     Single 
Tears  in  Period  1911  to  1916. 

Experience  of  Metropolitan  Life   Insurance   Company,  Industrial  Depart- 
ment, and  of  Expanding  Registration  Area  of  the  United  States. 


Year. 

Females,  Ages  15  to  44  Years. 

Death  Rate  per  100,000  Women  Exposed. 

Ratio,  Insurance 
to  Population, 
Reg.  Area  Rates. 

Insured 
White  Women. 

Women  In  Popu- 
lation, Reg.  Area. 

1916.  . 

25.3 
24.8 
28.6 
31.9 
26.9 

30.6 

* 

* 

25.4 
28.7 
29.2 
26.3 
29.9 
29.2 

* 

.98 
1.00 
1.09 
1.02 

1.02 

* 

1915  

1914  

1913  

1912  

1911  

1910  

*  Data  unavailable. 

We  have  found  from  our  previous  inquiry  that  the  conditions 
classified  as  puerperal  albuminuria  and  convulsions  are  second  in 
importance  among  the  total  causes  of  maternal  mortality.  For  this 
cause  of  death  we  have  recorded  a  steadily  rising  rate  with  but  one 
exception  year  by  year  between  1910  and  1915  for  women  aged  15  to 
44  years  in  the  experience  of  the  Eegistration  Area  and  a  fluctuating 
rate  among  white  females  in  the  insurance  experience. 

The  table  on  page  210  presents  a  comparison  of  the  data  available 
for  these  conditions  among  white  insured  women  and  among  women 
in  the  population  between  the  ages  of  15  and  44  years. 

This  is  a  discouraging  picture  in  view  of  the  well  established 
opinion  among  obstetricians  that  the  largest  part  of  the  mortality 
from  these  conditions  may  be  prevented  through  adequate  medical 
and  nursing  service  carried  on  during  the  period  of  pregnancy.  The 
figures  clearly  indicate  a  fruitful  field  for  the  extension  of  such 
service  to  women.  This,  in  fact,  is  the  reason  for  the  general  ex- 
lo 


210 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


tension  of  the  Company's  nursing  service  to  women  during  preg- 
nancy. Through  such  service  the  nephritic  and  hepatic  cases  will 
undoubtedly  be  brought  earlier  under  medical  observation  and  many 
cases  which  would  under  ordinary  circumstances  terminate  fatally 
as  puerperal  albuminuria  and  convulsions  will  thus  be  carried  safely 
through  their  confinement. 

TABLE  133. 
MORTALITY  FROM  PUERPERAL  ALBUMINURIA  AND  CONVULSIONS. 

Death  Eates  per  100,000  Women  Exposed,  Ages  15  to  44  Years.    Single 
Years  in  Period  1911  to  1916. 

Experience  of  Metropolitan  Life   Insurance  Company,  Industrial   Depart- 
ment, and  of  Expanding  Registration  Area  of  the  United  States. 


Year. 

Females,  Ages  15  to  44  Years. 

Death  Rates,  per  100,000  Women  Exposed 

Ratio  of  Insurance  to 
Population, 
Reg.  Area  Rates. 

Insured  White 
Women. 

Women  In  Popula- 
tion. Reg.  Area. 

1916.  . 

18.3 
16.9 
18.0 
19.0 
17.3 

17.1 

* 

* 

16.1 
16.1 
15.4 
14.6 
14.3 
13.7 

* 

1.05 
1.12 
1.23 
1.18 

1.20 

* 

1915  

1914  

1913  

1912  

1911  

1910  

*  Data  unavailable. 


Accidents  of  Labor. 


The  registered  mortality  from  these  causes  of  death  for  the  group 
of  white  insured  females,  shows  a  general  and  substantial  downward 
trend  from  1911  to  1916.  The  Registration  Area  mortality  rates 
show  the  peculiar  phenomenon  of  a  steady  downward  trend  up  to 
1913  and  a  gradual  rise  in  the  rate  between  1913  and  1915.  It  is 
not  possible  to  indicate  how  much  of  the  general  decline  in  mortality 
from  this  cause  among  insured  white  females  is  due  to  the  work  of 
the  Visiting  Nurse  Service.  Under  the  rules  of  that  service,  the 
work  of  the  visiting  nurse  is  confined  very  largely  to  after-care  of 
mothers  after  childbirth.  It  is  believed,  however,  that  the  amount 
of  prenatal  work  already  extended  to  insured  women  in  the  Indus- 
trial Department  tends  in  a  measure  to  correct  during  pregnancy 
the  remediable  mechanical  difficulties  which  may  be  encountered 
during  labor.  The  work  of  the  public  health  nurse  for  pregnant 


DISEASES    INCIDENTAL   TO    MATERNAL   STATE. 


211 


women  would  necessarily  be  in  the  direction  of  insuring  proper 
medical  care  for  women  in  childbirth.  We  show  the  comparative 
mortality  facts  for  accidents  of  labor  below : 

TABLE  134. 
MORTALITY   PROM   "OTHER  ACCIDENTS   OF   LABOR." 

Death  Bates  per  100,000  Women  Exposed,  Ages  15  to  44  Years.    Single 
Years  in  Period  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance   Company,   Industrial   Depart- 
ment, and  of  Expanding  Registration  Area  of  the  United  States. 


Year. 

Females,  Ages  15  to  44  Yean. 

Death  Rates  per  100,000  Women  Exposed. 

Ratio  of  Insurance 
to  Population, 
Reg.  Area  Rates. 

Insured 
White  Women. 

Women  In  Popu- 
lation, Reg.  Area. 

1916.  . 

6.2 
6.1 
6.2 
7.1 
6.1 

8.2 

* 

* 

5.9 
5.6 
5.4 
5.6 
6.2 
6.1 

* 

1.03 
1.11 
1.31 
1.09 

1.32 

* 

1915  

1914  

1913  

1912  

1911  

1910  

*  Data  unavailable. 

Puerperal  Hemorrhage. 

It  has  been  assumed  in  obstetrical  literature  generally  that  mor- 
tality among  women  in  the  wage  earning  groups  of  the  population 
from  puerperal  hemorrhage  was  more  common  than  in  general  unse- 
lected  populations.  Our  data  show,  however,  a  lower  death  rate 
except  in  one  year,  1914,  from  this  cause  among  white  insured  fe- 
males in  the  families  of  wage  earners  than  among  females  in  the 
general  population  of  the  Registration  Area  of  the  United  States. 
The  figures  indicate  an  uncertain  tendency  in  the  mortality  of  both 
groups.  Table  135  on  page  212  gives  a  view  of  the  data  available. 

Accidents  of  Pregnancy. 

Comparative  mortality  from  this  cause  of  death  shows  higher 
death  rates  in  1913,  1914  and  1915  among  insured  white  females 
than  among  females  in  the  general  population.  There  seems  to  be, 
in  general,  higher  mortality  from  the  accidents  of  pregnancy 
among  white  females  in  wage  earners'  families  than  among  females 


212 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


TABLE  135. 
MORTALITY  FROM  PUERPERAL  HEMORRHAGE. 

Death  Kates  per  100,000  Women  Exposed,  Ages  15  to  44  Years.     Single 
Tears  in  Period  1911  to  1916. 

Experience  of  Metropolitan   Life   Insurance   Company,  Industrial   Depart- 
ment, and  of  Expanding  Registration  Area  of  the  United  States. 


Yew. 

Females.  Ages  15  to  44  Yean. 

Death  Rate  per  100,000  Women  Exposed. 

Ratio  of  Insurance 
to  Population. 
Reg.  Area  Rate*. 

Insured  White 
Women. 

Women  In  Popula- 
tion Reg.  Area. 

1916         

5.2 
5.7 
6.2 
4.6 
4.9 

5.3 

• 

* 

6.0 
6.1 
6.3 
6.2 
5.8 
5.6 

* 

.95 
1.02 
.73 
.79 

.91 

* 

1915  

1914         

1913            

1912  

1911  

1910  

*  Data  unavailable. 

in  the  general  population.     Such  data  as  we  have  available  are  given 
in  the  following  table : 

TABLE  136. 
MORTALITY  FROM  ACCIDENTS  OF  PREGNANCY. 

Death  Sates  per  100,000  Women  Exposed,  Ages  15  to  44  Years.     Single 
Tears  in  Period  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance   Company,  Industrial  Depart- 
ment, and  of  Expanding  Registration  Area  of  the  United  States. 


Year. 

Females,  Ages  15  to  44  Years. 

Death  Rates  per  100,000  Women  Exposed. 

Ratio  of  Insurance  to 
Population 
Reg.  Area  Rates. 

Insured  WWte 
Women. 

Women  In  Popula- 
tion. Reg.  Area. 

1916.  . 

4.6 
6.1 
6.2 
5.9 
4.8 

6.1 

* 

* 

5.7 
5.5 
5.5 
5.8 
6.2 
6.6           i 

* 

1.07 
1.13 
1.07 
.83 

.98 

* 

1915  

1914   

1913             

1912                 

1911                     

1910  

Data  unavailable. 


DISEASES  INCIDENTAL  TO  MATERNAL  STATE.  213 

PREVENTION  OF  MATERNAL  MORTALITY. 

The  figures  presented  in  the  above  tables  disclose  a  large  and 
profitable  field  for  intensive  public  health  work.  It  is  no  light 
matter  that  with  the  present  development  of  sanitary  science  and 
of  preventive  medicine  there  should  still  be  one  fatal  termination  in 
from  every  100  to  200  cases  of  pregnancy  and  childbirth.  Yet  this 
is  the  situation  in  a  number  of  large  centers  of  population  for  which 
adequate  data  are  available.  As  we  have  pointed  out,  the  puerperal 
conditions  in  their  entirety  represent  a  hazard  to  the  life  of  women, 
which  is  second  only  to  that  from  pulmonary  tuberculosis  at  these 
childbearing  ages.  The  serious  social  losses  resulting  from  the 
many  deaths  of  women  at  these  ages  are  now  more  thoroughly 
realized.  Deaths  of  wives  and  mothers  mean,  in  most  instances, 
the  destruction  of  family  ties  with  their  incalculable  consequences 
to  the  community.  These  facts  explain  the  recent  efforts  for  the 
care  of  women  in  pregnancy.  Prenatal  work  is  fast  becoming  an 
integral  part  of  the  routine  of  preventive  work  of  the  departments 
of  health  of  many  American  cities.  In  some  communities,  like 
Boston  and  New  York,  private  agencies  cooperating  with  the  visit- 
ing nurse  associations,  have  specialized  in  the  nursing  of  women 
throughout  the  period  of  pregnancy,  confinement  and  after-care. 
Thousands  of  cases  are  being  cared  for  each  year  in  prenatal  clinics 
and  through  follow-up  and  instructive  visits  by  specialized  nurses. 
In  Boston,  the  work  has  been  brought  to  the  point  where  definite 
life  saving  of  both  mother  and  child  on  a  large  scale  already  appears 
evident.  Other  communities  will  undoubtedly  show  similar  results 
as  their  work  becomes  better  established. 

It  is  among  insured  women  that  the  best  results  of  a  policy  of 
life  conservation  have  been  obtained.  From  the  very  beginning,  in 
1909,  the  nursing  service  of  the  Metropolitan  Life  Insurance  Com- 
pany considered  the  care  of  women  after  childbirth  a  major  function 
of  the  service  and  this  has  been  the  policy  of  the  Company  since. 
In  1916,  out  of  a  total  of  160,843  female  policyholders  visited  dur- 
ing illness  41,572  or  25.8  per  cent,  were  cases  resulting  from  diseases 
or  conditions  of  the  puerperal  state.  While  the  majority  of  these 
cases  involve  care  of  women  after  normal  childbirth,  there  are  many 
cases  each  year  of  the  abnormal  and  acute  conditions  requiring 
intensive  nursing  care.  Thus,  in  1916  there  were  967  cases  of 
puerperal  septicemia,  308  cases  of  albuminuria  and  convulsions  and 


214          MORTALITY    STATISTICS   OP   INSURED   WAGE   EARNERS. 

3,469  cases  of  abortion  and  miscarriage.  In  all,  a  total  of  243,738 
nursing  visits  were  made  in  1916  to  these  women  either  before  or 
after  their  confinement. 

It  is  not  surprising,  therefore,  that  we  should  find  a  very  favorable 
course  in  the  mortality  of  these  insured  women  from  nearly  all  the 
conditions  incidental  to  childbearing.  In  the  six  year  period  be- 
tween 1911  and  1916,  the  death  rate  among  white  female  policy- 
holders*  from  these  causes  fell  10.7  per  cent.,  the  figures  for  1911 
and  1916  being  70.1  and  62.6  per  100,000  respectively.  The  per 
cent,  reduction  is  greater  in  this  period  for  colored  women,  namely, 
20.4  per  cent.  The  decline  in  mortality  from  puerperal  septicemia  is 
especially  marked  among  white  women  in  this  period,  being  17.3  per 
cent.  "With  the  exception  of  accidents  of  pregnancy,  the  saving  in 
mortality  between  1911  and  1916  is  greater  among  insured  women 
than  among  women  in  the  population  at  large  between  1910  and 
1915  as  represented  in  the  Eegistration  Area  data.  These  com- 
parisons, therefore,  serve  as  a  strong  endorsement  of  the  Company's 
programme  for  the  care  of  parturient  women  through  public  health 
nursing. 

*  Ages  15  to  44  years. 


CHAPTEE  XIV. 

We  shall  DOW  depart  from  the  practice  of  discussing  in  a  separate 
chapter  the  mortality  statistics  of  individual  diseases.  In  each  of 
Chapters  XIV,  XV  and  XVI  we  shall  group  a  number  of  causes  of 
death,  otherwise  unrelated,  into  chapters  of  convenient  length,  and 
shall  consider  the  respective  diseases  in  the  order  of  their  decreas- 
ing numerical  importance.  This  seems  advisable  because  the  dis- 
eases and  conditions  thus  discussed  are  not  of  sufficient  numerical 
importance  to  justify  the  extensive  treatment  accorded  to  those  in 
the  preceding  chapters.  This  grouping  must  not  be  considered  as 
an  expression  of  any  relation  between  the  diseases ;  our  arrangement 
is  determined  only  by  a  consideration  of  the  size  of  the  chapters. 
The  present  chapter  will  deal  with  the  following  diseases: 

1.  Diseases  of  the  Arteries,  Atheroma,  Aneurism,  etc. 

2.  Typhoid  Fever. 

3.  Cirrhosis  of  the  Liver. 

4.  Influenza. 

5.  Diabetes. 

DISEASES  OF  THE  ARTERIES,  ATHEROMA,  ANEURISM,  ETC. 

The  deaths  registered  under  this  title  include  those  certified  as 
due  to  arteriosclerosis,  and  to  other  arterial  diseases  such  as  fatty 
degeneration  of  the  arterial  wall  (atheroma)  and  aneurism  of 
various  types.  The  larger  proportion  of  the  9,142  deaths  under  this 
title,  however,  relate  to  general  arteriosclerosis.  In  all,  1.4  per  cent, 
of  the  deaths  in  the  total  experience  are  included. 

Eeports  on  mortality  from  arteriosclerosis  must  be  accepted  with 
caution  because  of  inherent  defects  in  the  statistics.  It  is  only  in 
recent  years  that  physicians  have  paid  serious  attention,  in  pre- 
paring death  certificates,  to  the  arterial  diseases  as  causes  of  death. 
Increasing  popular  interest  in  these  diseases  has  carried  with  it,  at 
the  same  time,  neglect  on  the  part  of  physicians  to  specify,  in  many 
cases,  the  associated  impairments  of  the  heart  and  kidney,  which,  if 
they  were  stated  as  they  should  be,  would  result  in  the  assignment  of 
the  cause  of  death  to  other  than  arterial  disease.  There  is  still, 

215 


216 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


therefore,  considerable  uncertainty  as  to  the  full  significance  of  the 
figures  on  arterial  disease  mortality  submitted  in  this  report. 

The  following  table  shows  the  death  rates  from  the  arterial  dis- 
eases, arranged  by  sex,  color  and  age : 

TABLE  137. 

MORTAUTY   FROM   DISEASES  OP  THE   ARTERIES,   ATHEROMA,    ANEURISM,   ETC. 

Death  Bates  per  100,000  Persons  Exposed.     1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

17.0 

18.8 

15.1 

21.3 

15.8 

1  to  24  

.1 
1.6 

5.8 
16.0 
66.0 
298.7 
888.8 

.1 

1.4 
6.6 
21.0 
87.8 
392.7 
1089.5 

.6 
1.7 
8.7 
50.3 
249.8 
804.5 

.3 
7.2 

25.8 
38.8 
79.8 
287.3 
686.0 

.4 
2.9 
8.1 
24.1 
67.8 
210.2 
653.3 

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

tLess  than  .05  per  100,000  exposed. 

We  find,  as  in  a  number  of  the  other  degenerative  diseases,  a 
marked  difference  in  the  two  races.  Colored  males,  especially  at  the 
earlier  ages  of  adult  life,  show  much  higher  mortality  rates  than  do 
white  males.  Colored  females,  likewise,  up  to  64  years,  show  exces- 
sive rates  from  this  cause.  After  age  55,  there  is  a  reversal  of  this 
condition  arid  the  rates  for  white  lives  exceed  those  for  the  colored. 
Males  show  higher  rates  than  females  in  each  race. 

A  comparison  of  the  death  rates  prevailing  among  the  insured 
lives  with  those  in  the  population  of  the  Registration  Area  shows  a 
marked  excess  in  the  former  group  during  the  significant  age 
periods.  Thus,  between  65  and  74,  white  insured  males  have  a  rate 
nearly  68  per  cent,  in  excess  of  that  of  the  male  population,  and 
insured  females  a  rate  63  per  cent,  in  excess  of  that  for  females  in 
the  Registration  Area. 

The  following  table  gives  a  few  of  the  comparative  facts  in  the 
two  experiences : 


DISEASES   OF   THE   ARTERIES. 


217 


TABLE  138. 
MORTALITY  FROM  DISEASES  OF  THE  ARTERIES,  ATHEROMA,  ANEURISM,  ETC. 

Death  Bates  per  100,000  Persons  Exposed.    Classified   by   Sex  and  Age 
Periods.     Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916}  and 
General  Population  of  Expanding  Eegistration  Area  of 
the   United  States   (1910  to   1915). 


Age  Period. 

Males. 

Females. 

M.  L.  I.  Co. 
(White). 

U.  8.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 

of  Reg.  Area. 

M.  L.  I.  Co. 
(White). 

U.  S.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 
of  Reg.  Area. 

25  to  34.. 
35  to  44.... 
45  to  54.... 
55  to  64.... 
65  to  74.... 
75  and  over 

1.4 

6.6 
21.0 
87.8 
392.7 
1089.5 

1.7 
5.8 
17.6 
61.3 
234.1 
983.4 

82.4 
113.8 
119.3 
143.2 
167.7 
110.8 

.6 

1.7 
8.7 
50.3 
249.8 
804.5 

.7 
2.2 
8.2 
35.4 
153.3 
743.7 

85.7 
77.3 
106.1 
142.1 
162.9 
108.2 

As  already  pointed  out,  it  is  very  doubtful  whether  we  have  con- 
clusive figures  as  to  the  true  incidence  of  these  diseases  at  the  pres- 
ent time.  The  trend  of  the  death  rates  between  1911  and  1916  may, 
therefore,  be  no  real  indication  of  the  general  tendency  of  the  dis- 
ease during  the  period.  The  uncertainties  of  diagnosis  and  certifi- 
cation are  still  too  dominant  to  warrant  drawing  any  far  reaching 
conclusions.  The  sudden  decline  in  the  death  rate  both  among 
white  females  and  white  males  subsequent  to  1914  was  clearly  the 
result  of  changed  office  practise  in  assigning  cases  where  arterio- 
sclerosis was  reported  jointly  with  a  number  of  other  conditions 
such  as  bronchopneumonia,  chronic  bronchitis,  endocarditis,  and 
many  other  causes.  Following  the  practise  of  the  Census  Bureau, 
such  cases  were,  after  1914,  assigned  not  to  arteriosclerosis  but  to  the 
accompanying  condition.  Among  insured  colored  persons,  there  is 
shown  a  fairly  marked  increase  in  the  rates  from  year  to  year 
despite  the  influence  of  this  factor.  The  figures  for  the  population 
of  the  Eegistration  Area  are  different  in  that  they  show  a  condition 
of  increased  incidence  from  year  to  year. 

The  following  table  shows  the  figures  for  the  individual  years 
between  1911  and  1916  differentiated  by  color  and  sex: 


218 


MOHTALITY    STATISTICS   OP   INSURED   WAGE   EARNERS. 


TABLE  139. 

MORTALITY  FROM  DISEASES  or  THE  ARTERIES,  ATHEROMA,  ANEURISM,  ETC., 
CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.    Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Peraona. 

White. 

Colored. 

Males. 

Females. 

Males.              Female*. 

1911  to  1916  

17.0 

18.8 

15.1 

21.3 

15.8 

1916 

15.2 
14.4 
18.9 
19.0 
17.6 
17.4 

16.5 
14.5 
21.2 
21.0 
20.5 
20.1 

13.2 
13.2 
17.2 
17.2 
15.3 
15.3 

21.8 
21.5 
21.0 
23.1 
20.5 
19.9 

16.9 
16.9 
16.2 
15.7 
15.0 
13.9 

1915  

1914  

1913  

1912  

1911  

TYPHOID  FEVER. 

Typhoid  fever,  according  to  Sir  William  Osier,  "  is  everywhere  an 
index  of  the  sanitary  intelligence  of  the  community."  It  is  encour- 
aging, with  this  statement  in  mind,  to  find  that  typhoid  fever  shows 
during  the  six  year  period  under  investigation  a  very  large  per- 
centage of  decrease  in  its  incidence.  It  is  still  a  cause  of  much  con- 
cern, however,  in  its  wide  distribution  and  in  the  considerable  num- 
ber of  deaths  that  annually  result  from  it.  A  wide  gulf  still  sepa- 
rates sanitary  knowledge  from  sanitary  accomplishment  over  a  large 
area  of  the  United  States.  It  will  be  possible,  through  the  examina- 
tion of  the  data  of  this  experience,  to  determine  the  comparative 
incidence  of  the  disease  in  the  two  color  or  race  groups  constituting 
the  American  working  population.  This  will  throw  light  on  the 
different  sanitary  surroundings  of  the  white  and  colored  people 
respectively.  Of  perhaps  equal  interest  to  the  medical  profession 
will  be  the  variable  incidence  of  mortality  from  the  disease  by  sex, 
and  in  the  several  main  age  periods  of  life. 

Typhoid  fever  caused  9,011  deaths  during  the  period  between 
1911  and  1916.  The  rate  of  mortality  was  16.8  per  100,000  living, 
the  disease  accounting  for  1.4  per  cent,  of  all  the  deaths. 

The  following  table  will  be  the  basis  of  our  discussion  of  the  inci- 
dence of  the  disease  in  the  two  race  and  sex  groups  according  to 
age  period : 


TYPHOID   FEVER. 


219 


TABLE  140. 

MORTALITY  FROM  TYPHOID  FEVER,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE 

PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

16.8 

15.8 

12.8 

35.6 

34.2 

1  to  4  

12.7 
12.9 
16.2 
24.6 
23.4 
18.5 
15.1 
13.1 
12.3 
11.8 
10.6 

10.8 
8.6 
12.4 
20.8 
24.3 
20.7 
17.1 
15.1 
15.2 
11.6 
9.9 

11.6 
11.5 
13.4 
20.0 
17.7 
13.2 
10.9 
8.7 
7.5 
7.9 
9.2 

28.8 
41.6 
35.4 
59.5 
46.7 
29.3 
26.4 
28.7 
27.6 
48.4 

35.5 
44.8 
58.4 
60.0 
38.8 
28.8 
20.7 
20.2 
22.0 
20.0 
36.3 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

It  is  evident  that  typhoid  fever  death  rates  show  very  pronounced 
differences  for  the  two  races.  Those  for  the  colored  persons  are 
greatly  in  excess  of  those  for  whites.  This  holds  true  for  every 
year  of  the  six  year  period.  The  rate  for  colored  males  (35.6)  is 
considerably  more  than  double  that  for  white  males  (15.8) ;  that  for 
colored  females  (34.2)  is  almost  three  times  that  for  white  females 
(12.8).  These  differences  between  the  races  are  even  more  marked 
when  we  consider  certain  of  the  age  periods,  especially  the  years  of 
childhood.  Thus,  between  the  ages  of  five  and  nine,  the  colored 
children  show  rates  between  four  and  five  times  as  high  as  those  for 
white  children  at  the  same  ages.  It  is  impossible  from  the  above 
data  to  say  definitely  to  what  extent  these  race  differences  indicate  a 
varying  degree  of  resistance  to  the  disease.  A  much  more  plausible 
explanation  is  that  the  great  body  of  the  colored  policyholders  reside 
in  those  areas  of  the  country  and  in  certain  definite  localities  of 
cities  where  typhoid  fever  is  much  more  prevalent  than  in  areas 
inhabited  'by  the  white  policyholders.  It  is  possible,  of  course,  that 
the  factor  of  resistance  plays  a  part  also,  but  this  can  be  determined 
only  by  future  research  which  will  take  into  consideration  all  of  the 
local  sanitary  surroundings  of  the  two  races. 


220         MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


The  variations  in  the  incidence  of  typhoid  fever  mortality  in  the 
two  sexes  are  less  pronounced,  but  are,  nevertheless,  in  evidence. 
Taking  all  ages  together,  males  show  higher  rates  than  females,  the 
differences  being  more  marked  among  the  whites  than  among  the 
colored.  On  further  analysis,  we  find  that  this  difference  results 
from  a  considerably  higher  death  rate  among  males  beginning  with 
the  age  period  20  to  24,  the  male  excess  increasing  with  advancing 
age.  In  the  earlier  ages,  that  is,  under  age  15,  there  is  a  pronounced 
excess  in  the  rate  of  females  of  both  races. 

Reference  has  already  been  made  to  the  varying  incidence  by  age 
in  this  condition.  We  may  summarize  the  facts  as  follows:  the 
highest  mortality  occurs  in  the  age  group  15  to  19  years,  although 
among  white  males,  this  maximum  figure  is  attained  in  the  next  age 
period,  20  to  24  years. 

TABLE  141. 

MORTALITY  FROM  TYPHOID  FEVER, 

Death  Rates  per  100,000  Persona  Exposed.     Classified  by   Sex  and  Age 
Periods.     Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  of  Expanding  Registration  Area  of 
the   United  States   (1910  to   1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  CO. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

15.8 

20.7 

76.3 

12.8 

14.7 

87.1 

Ito4.. 

10.8 

10.1 

106.9 

11.6 

10.0 

116.0 

5  to  9..     . 

8.6 

11.0 

78.2 

11.5 

12.3 

93.5 

10  to  14.     . 

12.4 

12.7 

97.6 

13.4 

15.7 

85.4 

15  to  19.     . 

20.8 

26.6 

78.2 

20.0 

22.9 

87.3 

20  to  24.     . 

24.3 

34.2 

71.1 

17.7 

21.0 

84.3 

25  to  34.     . 

20.7 

27.5 

75.3 

13.2 

15.2 

86.8 

35  to  44.     . 

17.1 

21.3 

80.3 

10.9 

12.4 

87.9 

45  to  54.     . 

15.1 

18.3 

82.5 

8.7 

11.8 

73.7 

55  to  64.     . 

15.2 

18.0 

84.4 

7.5 

11.3 

66.4 

65  to  74.     . 

11.6 

15.2 

76.3 

7.9 

12.1 

65.3 

75  and  over 

9.9 

10.3 

96.1 

9.2 

10.0 

92.0 

A  comparison  of  the  above  data  with  those  for  the  population  of 
the  Registration  Area  of  the  United  States  confirms  the  several 
important  relations  which  have  been  described.  We  find  again  a 
higher  incidence  of  the  condition  among  males  than  among  females 
at  all  ages  combined,  and  more  especially  in  the  ages  after  early 


TYPHOID   FEVER.  221 

adolescence.  We  find  also  that  the  periods  of  maximum  mortality 
are  in  exact  agreement  in  the  two  experiences.  Among  males  in  the 
Kegistration  Area  for  example,  the  highest  death  rate  for  any  period 
is  that  for  the  age  group  20  to  24  years  and,  for  females,  in  the 
period  15  to  19  years.  The  same  general  contour  of  the  curves  of 
mortality  by  age  period  for  each  of  the  two  sexes  is  to  be  noted,  that 
is,  a  maximum  mortality  in  the  period  of  early  adult  life  tapering 
down  to  a  minimum  at  the  two  extremes  of  life. 

The  table  on  page  220  presents  a  comparison  of  the  death  rate 
by  age  and  sex  for  insured  lives  with  corresponding  figures  for  the 
population  of  the  Registration  Area. 

The  general  correspondence  between  the  two  sets  of  figures  is  very 
marked  and  yet  there  are  important  differences  to  which  reference 
should  be  made.  Beginning  with  the  period  5  to  9  years,  the 
rates  are  uniformly  higher  for  the  population  of  the  Registration 
Area,  the  most  marked  difference  being  found  in  the  age  period  20 
to  24  years.  For  each  sex  there  is  a  decided  advantage,  apparently, 
in  favor  of  the  insured  white  lives  as  compared  with  the  general 
population.  It  is  undoubtedly  true  that  the  Registration  Area 
figures  are  somewhat  higher  because  of  their  inclusion  of  a  small 
proportion  of  colored  lives,  but  perhaps  a  more  significant  factor  is 
the  fact  that  a  large  proportion  of  the  population  of  the  Registration 
Area  is  rural  in  character  whereas,  the  insured  lives  are  almost 
entirely  limited  to  cities  and  their  immediate  environment  where 
typhoid  fever  rates  are  nearly  always  lower  than  in  the  country. 
On  the  other  hand,  it  should  not  be  overlooked  that  a  considerable 
proportion  of  the  policyholders  of  the  Company  reside  in  certain  of 
the  non-registration  States  of  the  country  where  typhoid  fever  is 
more  prevalent  than  in  those  States  which  constitute  the  Registra- 
tion Area.  All  things  considered,  typhoid  fever  is  not  as  favorable 
a  condition  for  purposes  of  comparison  as  are  some  others.  The 
figures  submitted  do,  however,  confirm  the  essential  relations  of  the 
disease  in  both  groups  and  serve  to  show  that  wage  earners  and  their 
families  do  not  suffer  unduly  from  its  effects. 

The  decreasing  death  rate  from  typhoid  fever  is  one  of  the  very 
gratifying  features  of  this  mortality  experience.  There  was  a  con- 
tinuous and  marked  decrease  in  the  mortality  rate  year  by  year, 
beginning  with  1911  and  closing  with  1915.  A  slight  increase  is  in 
evidence  for  1916  as  compared  with  1915,  but  the  significance  of 


222 


MORTALITY   STATISTICS  OP   INSURED   WAGE  EARNERS. 


this  cannot  be  evaluated  at  this  time.    The  following  table  gives  the 
figures  for  each  of  the  six  years  in  the  period  by  sex  and  by  color : 

TABLE  142. 

MORTAUTT  FROM  TYPHOID  FEVER,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Sates  per  100,000  Person*  Exposed.    Single  Tears  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

16.8 

15.8 

12.8 

35.6 

34.2 

1916  

13.0 
12.9 
16.1 
18.4 
19.1 
22.8 

12.1 
12.1 

15.5 
17.7 
17.9 
21.2 

10.1 
9.8 
12.1 
14.2 
14.6 
17.7 

27.1 
31.8 
35.5 
38.0 
37.5 
45.8 

28.0 
25.4 
31.5 
35.5 
40.5 
46.5 

1915  

1914  

1913  

1912  

1911  

A  comparison  of  the  above  figures  with  those  for  the  Registration 
Area  shows  a  number  of  coincidences.  The  rate  for  1911  in  the 
Registration  Area  was  also  the  highest  for  the  quinquennium  1911 
to  1916;  that  for  1915  was  the  lowest  for  the  same  period.  Again. 
a  slight  rise  is  shown  for  1916  over  1915  in  the  population  data.  In 
other  words,  the  fluctuations  in  the  insurance  experience  serve  here 
as  a  very  sensitive  index  of  the  fluctuations  in  the  general  popula- 
tion experience. 

Mortality  from  Sequelae  of  Typhoid  Fever. 

Before  closing  this  section,  it  will  be  well  to  refer  to  one  additional 
feature  of  typhoid  mortality  which  the  data  under  consideration 
make  possible,  namely  the  sequelae  of  typhoid  fever.  A  study  made 
in  1914*  of  a  group  of  more  than  1,000  persons  who  had  recovered 
from  an  attack  of  typhoid  fever  in  1911  showed  clearly  that  in  the 
three  year  period  following  the  disease  the  mortality  was  slightly 
more  than  double  what  might  be  normally  expected  from  persons  in 
the  same  age  and  sex  classes.  It  was  found  that  during  the  first  year 
after  recovery  close  to  three  times  the  expected  number  of  deaths 

•Dublin,  Louis  I.,  "Typhoid  Fever  and  Its  Sequelae,"  Metropolitan  Life 
Insurance  Company,  1914. 


CIRRHOSIS  OF   THE   LIVER.  228 

occurred  (284  per  cent).  During  the  second  year,  the  ratio  of 
actual  to  expected  mortality  was  217  per  cent.,  and,  during  the  third 
year,  the  ratio  was  only  80  per  cent.  This  would  indicate  that  the 
effect  of  an  attack  of  typhoid  fever  continues  over  a  period  of  two 
years,  during  which  time  there  is  a  marked  increase  in  the  mortality 
from  certain  conditions  which  apparently  are  induced  by  typhoid 
fever.  These  are  tuberculosis,  diseases  of  the  heart,  and  diseases  of 
the  kidney,  which  all  appear  in  exaggerated  proportions  as  causes 
of  death  in  the  group  of  survivors. 

In  considering  typhoid  mortality,  therefore,  it  is  well  to  remember 
that,  in  addition  to  the  death  rate  from  the  disease,  there  is  also  the 
added  element  of  impairment  which  follows  in  the  track  of  recovered 
cases,  taking  a  toll  of  approximately  double  mortality  during  the 
period  of  from  two  to  three  years  after  "  recovery "  from  typhoid 
fever.  It  is  estimated  that  in  the  period  from  1911  to  1916,  when 
9,011  deaths  from  typhoid  fever  occurred  in  the  Industrial  experi- 
ence of  the  Metropolitan  Life  Insurance  Company,  an  additional 
3,600  deaths  occurred  among  those  who  had  been  attacked  by  ty- 
phoid fever  but  who  had  recovered — evidently  a  significant  addi- 
tion to  the  mortality  due  to  any  cause  of  death. 

CIRRHOSIS  OF  THE  LIVER. 

Eight  thousand  and  sixty-four  (8,064)  deaths  of  Metropolitan 
policyholders  were  recorded  as  due  to  cirrhosis  of  the  liver  during 
the  six  year  period  1911  to  1916.  The  death  rate  was  15.0  per 
100,000  exposed.  Included  under  this  title  are  deaths  from  alcoholic 
cirrhosis,  but  not  those  in  which  the  disease  is  definitely  reported  as 
a  sequela  of  syphilis.  Alcoholism  is  recognized  as  the  chief  cause  of 
cirrhosis  of  the  liver.  It  must  be  clear,  therefore,  that  a  large  num- 
ber of  cases  of  alcoholism  are  not  reported  in  the  published  statistics 
where  cirrhosis  of  the  liver  is  registered  as  the  cause  of  death.  All 
statistics  in  any  way  related  to  mortality  from  alcoholism  are  still 
understatements. 

Color,  Sex  and  Age  Incidence  of  Mortality  from  Cirrhosis  of  ihe 

Liver. 

The  death  rate  for  white  policyholders  was  higher  than  that  for 
colored  policyholders  for  each  sex  group.  This  applies  to  the  four 
ten-year  age  periods  of  heaviest  mortality  from  the  disease  extend- 


224 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


ing  from  age  35  to  age  75.  After  age  75,  the  rate  for  white  males 
was  also  higher  than  for  colored  males,  but,  among  females,  the 
color  relation  was  reversed.  This  may  well  be  due  to  the  unre- 
liability of  the  data  for  colored  females  at  this  advanced  age  period 
of  life.  The  following  table  presents  the  facts  by  color,  sex  and 
by  age: 

TABLE  143. 

MORTALITY  FROM  CIRRHOSIS  OF  THE  LIVER,  CLASSIFIED  BY  COLOR,  SEX  AND 

BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

15.0 

20.7 

10.6 

18.8 

9.6 

1  to  19  .  . 

.4 
1.0 

6.7 
24.4 
48.8 
66.8 
98.6 
102.8 

.4 
1.1 

9.8 
39.9 
87.8 
114.8 
145.7 
124.8 

.3 

.4 
4.1 
16.5 
29.0 
40.6 
71.3 
91.2 

1.2 

3.3 
10.7 
28.6 
47.6 
73.8 
111.9 
82.3 

1.3 
2.4 
5.3 
11.1 
22.2 
27.7 
64.6 
99.8 

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  ..    . 

65  to  74  

75  and  over.  . 

The  rates  are  also  much  higher  for  males  than  for  females.  This 
applies  to  both  white  and  colored  policyholders  at  all  of  the  signifi- 
cant age  periods.  The  mortality  is  low  in  early  life.  Beginning 
with  the  age  period  25  to  34  years,  the  rate  becomes  important,  and, 
after  that,  rises  rapidly,  reaching  the  maximum,  for  significant  age 
groups,  at  the  period  of  65  to  74  years.  Both  white  and  colored 
males  show  a  decrease  in  the  death  rate  after  age  75,  while  females 
of  both  races  show  significant  increases  in  the  rate.  It  is  possible 
that  these  variations  are  accidental  as  the  result  of  the  small  num- 
ber of  lives  exposed  at  the  advanced  periods  of  life. 

Comparison  of  Mortality  from  Cirrhosis  of  Liver  among  Insured 

Wage  Earners  1911  to  1916  and  among  the  Population  of  the 

Expanding  Registration  Area,  1910  to  1915. 

Comparison  with  available  data  by  sex  and  age  for  the  expanding 
Registration  Area  shows  that  the  mortality  among  insured  white 


CIRRHOSIS   OF   THE   LIVER. 


225 


males  exceeds  very  slightly  that  for  the  males  of  the  general 
population  (20.7  per  100,000  exposed  as  compared  with  18.0  per 
100,000  population).  For  the  females,  the  corresponding  rates  are 
10.6  and  8.9.  In  each  experience,  it  will  be  noted  that  the  mortality 
among  males  is  about  double  that  among  females.  As  might  be 
expected,  the  death  rates  for  the  lower  age  periods  are  not  signifi- 
cant in  either  experience.  It  is  not  until  age  35  is  reached  that 
cirrhosis  of  the  liver  becomes  a  serious  factor  in  mortality.  From 
that  age  on,  the  death  rate  for  cirrhosis  of  the  liver  is  very  much 
higher  among  white  insured  men  and  women  than  it  is  in  the 
Registration  Area.  At  the  age  period  35  to  44  years,  for  males,  the 
death  rate  for  the  policyholders  is  39.9  as  compared  with  19.2  for 
males  of  the  general  population.  For  those  45  to  54  years  of  age, 
the  corresponding  rates  are  87.8  and  44.1.  While  the  excess  is 
smaller  in  the  three  highest  age  groups,  it  is,  nevertheless,  very  pro- 
nounced in  each  case.  For  the  females,  practically  the  same  rela- 
tions are  in  evidence,  although  the  rates  are  lower.  In  each  age 
period,  there  is  found  a  markedly  higher  rate  among  the  Industrial 
policyholders.  It  is  believed  that  in  the  case  of  cirrhosis  of  the 
liver,  as  with  many  other  diseases  in  which  the  death  rates  for  the 
insured  exceed  those  of  the  general  population,  the  explanation  is 

TABLE  144. 
MORTALITY  FROM  CIRRHOSIS  OP  THE  LIVER. 

Death  Kates  per  100,000  Persons  Exposed.     Classified  by  Sex  and  by  Age 
Periods.     Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  of  Expanding  Registration  Area  of 
the  United  States    (1910  to  1915). 


Age  Period. 

Males. 

Females. 

M.  L.  I.  Co. 

(White). 

IT.  8.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 
of  Reg.  Area. 

M.  L.  I.  Co. 

(White)  . 

U.  S.  Reg. 
Area. 

Per  Cent. 
M.  L.  I.  Co. 
of  Reg.  Area. 

All  ages  —  one 
and  over  .... 

1  to  19.... 
20  to  24.... 
25  to  34.... 
35  to  44.... 
45  to  54.... 
55  to  64.... 
65  to  74.... 
75  and  over 

20.7 

18.0 

115.0 

10.6 

8.9 

119.1 

.4 
1.1 
9.8 
39.9 
87.8 
114.8 
145.7 
124.8 

.4 
.9 
5.3 
19.2 
44.1 
74.9 
104.7 
108.7 

100.0 
122.2 
184.9 
207.8 
199.1 
153.3 
139.2 
114.8 

.3 

.4 
4.1 
16.5 
29.0 
40.6 
71.3 
91.2 

.4 
.7 
3.0 
9.8 
19.5 
31.5 
53.9 
73.9 

75.0 
57.1 
136.7 
168.4 
148.7 
128.9 
132.3 
123.4 

226         MORTALITY   STATISTICS  OF   INSURED   WAGE  EARNERS. 

found  in  part  in  the  different  distribution  of  the  exposure  with 
reference  to  rural  and  urban  residence.  Examination  of  the  gen- 
eral population  mortality  reports,  year  after  year,  shows  that  for  this 
disease  the  urban  mortality  is  in  the  neighborhood  of  50  per  cent,  in 
excess  of  the  rural.  The  fact  that  the  insured  exposure  is  almost 
entirely  urban  in  character  is  undoubtedly  an  important  element  in 
their  higher  death  rate.  The  special  circumstances  which  give  rise 
to  a  higher  urban  rate  for  this  disease  are  at  present  unknown. 

The  table  on  page  225  presents  a  comparison  of  the  death  rates 
for  cirrhosis  of  the  liver  by  age  and  sex  in  the  general  population 
and  among  the  Industrial  policyholders. 

Trend  of  the  Death  Rate  from  Cirrhosis  of  the  Liver. 
The  highest  mortality  during  the  six  year  period  was  encountered 
in  the  year  1912  (16.7)  while  the  lowest  was  for  the  year  1916 
(13.6).  There  were  no  marked  fluctuations  in  the  mortality, 
although  the  trend  in  both  the  Metropolitan  experience  and  that  of 
the  expanding  Registration  Area  was  downward. 

INFLUENZA. 

True  epidemic  influenza  is  a  specific  infectious  disease.  Several 
times  within  the  last  two  decades  of  the  nineteenth  and  in  the 
second  decade  of  the  present  century  it  has  been  epidemic  or  en- 
demic in  this  country,  notably  in  1889,  1890  and  in  1915  and  1916. 
From  the  statistical  standpoint,  however,  it  is  still  necessary  to 
exercise  great  caution  in  considering  this  disease.  The  word  "  in- 
fluenza "  is  a  term  which  is  very  loosely  used  by  physicians  and  in 
many  cases  in  which  it  is  given  as  the  cause  of  death  it  is  in  error, 
the  true  cause  being  some  other  condition  accompanied  with  respira- 
tory symptoms.  It  is  very  necessary  to  bear  this  in  mind  in  com- 
paring the  death  rate  for  influenza  for  a  period  of  years  and  in  fact 
in  evaluating  the  extent  of  the  mortality  from  the  condition  at  the 
present  time.  It  should  not  be  lost  sight  of,  however,  that  the 
tendency  to  use  the  term  correctly  is  becoming  more  and  more 
marked  as  the  years  go  on. 

The  8,056  deaths  which  were  ascribed  to  influenza  during  the 
period  1911  to  1916  were  therefore  an  over-statement  of  the  num- 
ber, although  it  is  impossible  to  determine  the  element  of  error. 
The  death  rate  based  on  this  number  of  deaths  was  15.0  per  100,000 


INFLUENZA. 


227 


living.  During  the  six  year  period  the  highest  rate  was  for  1916 
(23.8) ;  the  minimum  rate  was  observed  in  the  year  1914  (11.3). 
The  incidence,  therefore,  more  than  doubled  in  a  short  span  of  two 
years,  showing  clearly  the  epidemic  character  of  the  disease.  In  the 
expanding  Eegistration  Area  of  the  United  States  also,  much  the 
same  condition  prevailed.  The  mortality  in  1916  reached  a  rate  of 
26.4  per  100,000,  by  far  the  highest  rate  in  the  history  of  the  United 
States  Kegistration  Area  and  exceeding  by  65  per  cent,  the  rate  for 
the  year  before.  The  disease  was  especially  prevalent  and  virulent 
in  various  parts  of  the  country  during  the  latter  part  of  1915  and 
in  the  early  months  of  1916,  which  accounts  for  the  marked  increase 
shown  in  the  death  rates,  both  in  the  reports  of  the  United  States 
Census  Bureau  and  in  the  Industrial  experience  of  the  Metropolitan. 
The  following  table  presents  the  data  for  each  of  the  six  years 
between  1911  and  1916  by  color  and  sex: 

TABLE  145. 

MORTALITY  FROM  INFLUENZA,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Kates  per  100,000  Persons  Exposed.    Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.    Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

15.0 

11.3 

14.0 

26.5 

33.6 

1916  

23.8 
13.0 
11.3 
12.3 
12.3 
15.9 

18.7 
9.4 
8.3 
9.4 
8.9 
11.9 

24.2 
12.1 
10.7 
11.4 
10.0 
14.2 

34.9 
28.3 
20.6 
23.9 
25.5 
25.3 

44.1 
29.0 
25.8 
25.9 
35.8 
41.3 

1915  

1914  

1913  

1912  

1911  

Influenza  Mortality  According  to  Color,  Sex  and  Age. 

The  mortality  from  this  disease  is  most  prominent  at  the  two 
extremes  of  life,  especially  at  the  older  ages  when  very  high  death 
rates  are  attained.  The  lowest  rates  are  observed  between  the  ages 
5  and  35  years.  From  age  35  onward  the  incidence  rapidly  in- 
creases, more  than  doubling  with  each  successive  age  period. 

The  above  facts  with  regard  to  age  period  are  generally  true  for 
both  sexes  and  both  races.  The  death  rate  for  colored  policyholders 


228 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


is  more  than  double  that  for  white  persons  for  each  sex.  This  dif- 
ference between  the  two  race  groups  becomes  very  marked  in  some 
of  the  lower  age  periods,  when  the  rate  for  the  colored  is  more  than 
three  times  that  for  the  white. 

Females  show  uniformly  higher  rates  than  males  in  both  race 
groups.  This  is  especially  marked  in  the  period  of  middle  life  and 
of  old  age  when  the  death  rates  are  highest.  The  following  table 
presents  the  facts  for  influenza  by  color,  sex  and  age  period  during 
the  six  year  period : 

TABLE  146. 

MORTALITY  FROM  INFLUENZA,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

15.0 

11.3 

14.0 

26.5 

33.6 

1  to  4  

13.1 
3.5 
2.4 
3.6 
4.7 
6.7 
11.2 
22.2 
53.9 
148.0 
315.0 

12.6 
2.9 
1.8 
2.7 
3.4 
5.0 
10.8 
18.9 
44.9 
121.2 
235.5 

11.8 
3.4 
2.2 
2.6 
3.5 
4.7 
7.6 
17.5 
45.7 
142.4 
329.0 

28.8 
7.5 
4.1 
9.3 
10.5 
16.3 
23.8 
40.4 
94.8 
230.5 
397.9 

20.3 
5.8 
8.4 
13.2 
15.3 
15.9 
21.3 
49.7 
124.1 
285.4 
617.0 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

That  very  similar  relations  in  the  death  rates  by  sex  and  age  pre- 
vail in  the  general  population  of  the  United  States  is  shown  by  the 
data  for  the  expanding  ^Registration  Area,  1910  to  1915.  It  will 
not  be  necessary,  however,  because  of  the  element  of  uncertainty  in 
the  rates  for  influenza  to  give  the  actual  figures  for  the  Eegistration 
Area.  It  should  be  noted  nevertheless  that  the  mortality  rates  from 
this  condition  are  much  higher  among  the  white  urban  policy- 
holders  than  in  the  population  of  the  Eegistration  Area  for  each 
sex  and  at  virtually  every  age  period. 


DIABETES. 


229 


DIABETES. 

The  data  on  diabetes  in  this  experience  of  insured  wage  earners 
are,  so  far  as  we  can  determine,  original  in  the  literature  of  Ameri- 
can vital  statistics.  In  spite  of  the  intense  interest  of  the  medical 
profession  in  the  subject  in  recent  years,  little  has  been  done  so  far 
to  determine  the  extent  to  which  the  condition  is  responsible  for 
mortality.  The  figures  herein  submitted  are  not  only  accurate 
measures  of  the  incidence  of  the  disease  as  a  cause  of  death  in  gen- 
eral, but,  what  is  perhaps  more  important,  they  give  a  picture  of  the 
history  of  the  condition  in  relation  to  sex,  color  and  age  period.  To 
the  clinician  and  the  laboratory  student  of  the  disease,  the  relations 
presented  may  well  serve  as  a  clue  in  directing  further  diabetes 
research.  Another  element  of  interest  inherent  in  these  figures  is 
that,  referring,  as  they  do,  to  the  industrial  population,  they  may 
throw  light  on  the  probable  effect  of  social  and  economic  condition 
upon  the  incidence  of  diabetes.  This  is  still  a  mooted  question  in 
the  medical  literature.  There  is  a  tendency  in  some  quarters  to  re- 
gard the  disease  as  more  prevalent  among  the  prosperous  elements 
of  the  population.  On  the  other  hand,  certain  exciting  causes  in- 
herent in  the  harsher  conditions  of  life  and  work  have  been  identi- 
fied in  the  case-histories  of  diabetes  mellitus.  It  will  be  important, 

TABLE  147. 

MORTALITY  FROM  DIABETES,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

14.4 

10.8 

18.5 

9.5 

11.4 

1  to  4  

1.8 
1.7 
3.4 
4.0 
4.0 
5.4 
9.3 
30.4 
80.1 
127.2 
134.9 

1.9 
1.6 
3.1 

4.5 
5.0 
6.5 
10.6 
25.4 
56.6 
95.5 
102.1 

1.9 
1.8 
4.1 
4.0 
3.7 
4.9 
8.8 
34.3 
102.1 
161.4 
158.2 

2.3 
.3 
2.6 
3.3 

4.7 
9.6 
20.8 
48.6 
55.1 
109.8 

1.9 
.6 

2.5 
1.5 
.8 
4.3 
7.7 
33.5 
53.7 
57.5 
108.9 

5  to  9   

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

230          MORTALITY    STATISTICS  OF   INSURED   WAGE  EARNERS. 

therefore,  to  see  later  how  the  figures  here  presented  compare  in 
detail  with  those  in  the  general  population  whose  economic  status  is 
altogether  more  favorable.  If  the  number  of  deaths  in  this  ex- 
perience (7,762)  are  not  as  many  as  for  other  conditions  which  have 
been  discussed,  it  should  be  remembered  that  this  number  is  by  far 
the  largest  aggregation  of  cases  of  this  disease  which  have  as  yet 
received  extended  statistical  treatment. 

The  table  on  page  229  presents  the  death  rates  per  100,000 
persons  exposed  with  respect  to  color,  sex  and  age  period. 

The  death  rate  increases  with  age.  "Under  35  years,  there  is  no 
very  appreciable  incidence  of  the  condition.  Between  ages  ten  and 
fourteen,  a  rate  of  3.4  deaths  per  100,000  persons  living  is  the  first 
indication  of  a  significant  distribution  in  the  population  of  the 
disease  in  its  malignant  form.  Between  25  and  34  years,  the  rate, 
5.4,  accentuates  the  earlier  finding.  Beyond  35  years,  there  is  a 
rapid  rise  in  the  slope  of  the  curve  for  diabetes.  The  highest  point 
is  observed  in  the  last  age  period,  namely,  75  and  over.  But,  even 
in  the  more  significant  age  period  of  65  to  74  years  the  rate  is  not 
far  from  its  maximum.  In  fact,  among  white  females,  the  maxi- 
mum is  reached  in  this  period. 

There  is  a  lower  death  rate  among  colored  persons  at  each  of  the 
age  periods,  and  this  is  especially  true  of  colored  females  as  com- 
pared with  white  females.  The  difference  in  favor  of  colored  live? 
becomes  more  important  beyond  age  55,  when  diabetes  is  an  im- 
portant condition.  It  should  be  noted  also  that  diabetes  has  a  very 
marked  sex  incidence,  the  rates  beyond  age  45  being  for  both  white 
and  colored  women  higher  than  for  males  of  the  corresponding  race. 
There  is  only  one  exception  and  it  is  not  a  significant  one.  Prior 
to  age  45,  the  condition  is  reversed.  This  suggests  the  inter- 
esting question  whether  the  menopause  may  not  have  some  influence 
in  changing  the  sex  ratio  of  diabetes  mortality  after  45  years  of  age. 

Diabetes  Mortality  Among  Insured  Wage  Earners  and  Among  the 
General  Population  of  the  United  States  (Expanding  Registra- 
tion Area)  Compared. 

Among  males,  under  20  years  of  age,  and,  among  females  under 
35  years  of  age,  in  this  insurance  experience,  the  diabetes  death 
rates  are,  almost  without  exception,  lower  than  the  corresponding 
rates  for  the  population  in  the  Registration  Area  of  the  United 


DIABETES. 


231 


States.  Beyond  20  years  of  age,  however,  there  is  an  excess  in  the 
rate  among  insured  white  males  which  increases  up  to  the  period  35 
to  44.  Beyond  this  age,  the  excess  declines  to  a  point  where  the 
rates  for  the  two  groups  are  much  the  same.  Among  the  females, 
there  are  significantly  higher  rates  for  insured  women  than  for  those 
in  the  general  population.  Beginning  with  the  age  period  45  to  54 
years,  the  amount  of  excess  varies  somewhat  from  25  to  30  per  cent. 
The  following  table  presents  a  comparison  for  the  disease  in 
the  two  series,  that  is,  the  insured  group  and  the  general  Eegistra- 
tion  Area  population : 

TABLE  148. 

MORTALITY  FROM  DIABETES. 

Death  Rates  per  100,000  Persons  Exposed.    Classified  "by  Sex  and  "by  Age 
Periods.    Insured  White  Lives  in  Experience  of  Metropolitan  Life  In- 
surance Company,  Industrial  Department  (1911  to  1916)  and 
General  Population  of  Expanding  Registration  Area  of 
the  United  States   (1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  CO. 

tr.  S.  Reg 

Per  Cent. 
M.  T...  T.  f!n. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Per  Cent. 
M.  L.  I.  Co. 

(White).  . 

Area.        of  Reg  Area 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over  .... 

10.8 

14.5 

74.5 

18.5 

17.5 

105.7 

1  to  4  

1.9 

2.2 

86.4 

1.9 

1.8 

105.6 

5  to  9  

1.6 

3.0 

53.3 

1.8 

3.0 

60.0 

10  to  14.... 

3.1 

4.2 

73.8 

4.1 

4.8 

85.4 

15  to  19.... 

4.5 

4.8 

93.8 

4.0 

4.1 

97.6 

20  to  24.... 

5.0 

4.8 

104.2 

3.7 

3.8 

97.4 

25  to  34.... 

6.5 

5.6 

116.1 

4.9 

5.2 

94.2 

35  to  44.... 

10.6 

8.6 

123.3 

8.8 

8.3 

106.0 

45  to  54.... 

25.4 

22.6 

112  A 

34.3 

27.5 

124.7 

55  to  64.... 

56.6 

57.4 

98.6 

102.1 

78.4 

130.2 

65  to  74.  ... 

95.5 

95.0 

100.5 

161.4 

127.9 

126.2 

75  and  over 

102.1 

112.8 

90.5 

158.2 

121.2 

130.5 

Trend  of  the  Death  Rate  from  Diabetes. 

In  this  experience  for  insured  wage  earners,  there  is  a  slight 
tendency  toward  increase  in  the  recorded  death  rate  for  diabetes 
mellitus  There  is  some  significance  attached  to  this  increase  in 
mortality  from  the  disease.  There  are  no  important  nosologic  con- 
siderations confusing  the  statistics  for  diabetes  as  was  observed  for 
several  other  diseases  and  conditions,  notably,  cancer.  Fatal  dia- 
betes is  well  reported  in  this  mortality  experience  and  the  certifica- 


232 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


tion  of  the  disease  has  probably  not  improved  materially  during  the 
period  covered  by  this  experience.  The  minimum  rate  was  observed 
in  1911,  13.3  per  100,000  persons  exposed.  The  group  of  insured 
white  females,  as  in  other  years,  was  very  largely  responsible  for  the 
high  figure  shown  in  1916  for  the  entire  experience.  In  1911,  in- 
sured white  females  registered  a  diabetes  rate  of  16.5  per  100,000 
exposed ;  in  1916,  the  figure  was  20.2  per  100,000. 

In  the  experience  of  the  Registration  Area  of  the  United  States, 
there  has  been  also  observed  since  1900  a  gradual  increase  in  the 
death  rate  of  diabetes  mellitus. 

The  figures  for  the  individual  years  are  shown  herewith  by  color 
and  sex : 

TABLE  149. 
MORTALITY  PROM  DIABETES,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed,    Single  Years  in  Period  1911 

to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial 
Department. 


Year.. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

14.4 

10.8 

18.5 

9.5 

11.4 

1916    

15.9 
15.1 
14.2 
13.9 
13.7 
13.3 

11.5 
10.3 
10.5 

10.8 
10.3 
11.3 

20.2 
20.0 
18.4 
17.5 
17.7 
16.5 

11.6 
8.1 
10.0 
8.9 
9.7 
8.1 

14.8 
14.4 
10.4 
10.9 
9.2 
7.7 

1915  

1914  

1913  

1912  

1911  

CHAPTER  XV. 

This  chapter  will  deal  with  the  following  diseases: 

(1)  Appendicitis. 

(2)  Hernia,  Intestinal  Obstruction. 

(3)  Syphilis. 

(4)  Chronic  Bronchitis. 

(5)  Rheumatism. 

(6)  Acute  Bronchitis. 

(7)  Alcoholism,  Acute  and  Chronic. 

APPENDICITIS. 

Interest  attaches  to  the  statistical  treatment  of  appendicitis  in 
view  of  the  increased  accuracy  of  the  returns  in  recent  years  for  this 
condition.  Many  deaths  are  now  classed  properly  as  due  to  appen- 
dicitis which  some  years  ago  would  have  been  charged  to  "peri- 
tonitis." Fortunately,  the  many  deaths  classified  as  due  to  appen- 
dicitis in  this  experience  covered  a  period  during  which  every  effort 
was  made  to  assign  these  deaths  to  their  proper  cause. 

The  total  number  of  deaths  from  appendicitis  during  the  period 
1911  to  1916  was  6,345,  corresponding  to  a  death  rate  of  11.8  per 
100,000  exposed.  The  death  rate  for  colored  insured  persons  is 
slightly  higher  than  that  for  white  lives.  This  is  true  for  each 
sex,  although  the  difference  between  colored  females  and  white 
females  is  the  more  marked.  The  rate  for  males  is  slightly  higher 
than  for  females  among  both  white  and  colored  policyholders.  A 
more  careful  examination  of  the  mortality  curve  shows  some  very 
interesting  characteristics  by  age  period.  Thus,  the  age  period  of 
maximum  incidence  is  at  15  to  19  years.  This  is  true,  with  the 
exception  of  the  white  female  group,  for  each  one  of  the  race  and 
sex  categories  in  this  experience.  From  this  age  period  onward, 
me  rates  decline  for  a  period  of  twenty-five  to  thirty-five  years. 
The  rates  then  increase  somewhat  only  to  decline  again.  The  sug- 

233 


234 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


gestion  of  Stouman*  that  the  curve  of  mortality  for  this  disease 
is,  in  fact,  a  combination  of  two  curves,  both  skew,  appears  to  be 
confirmed  by  our  figures.  Only  additional  medical  research  can 
clear  up  the  true  meaning  of  this  characteristic. 

The  following  table  presents  the  death  rates  for  appendicitis  by 
color,  sex  and  age  period : 

TABLE  150. 

MORTALITY  FROM  APPENDICITIS,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

11.8 

13.2 

10.2 

13.9 

12.8 

1  to  4  . 

4.7 
10.1 
13.9 
15.7 
12.9 
12.4 
11.6 
11.8 
11.3 
10.8 
11.0 

4.8 
10.6 
15.6 
18.3 
15.6 
13.6 
13.2 
12.4 
14.2 
13.3 
17.0 

4.8 
9.9 
12.6 
12.4 
9.9 
10.9 
9.3 
11.1 
9.4 
9.2 
9.2 

5.8 
9.7 
15.8 
18.5 
14.1 
13.5 
14.4 
16.3 
12.0 
13.4 

.6 
7.0 
9.0 
19.0 
15.9 
15.0 
15.8 
10.2 
11.0 
9.4 

5  to  9  

10  to  14  
15  to  19  

20  to  24  

25  to  34 

35  to  44  

45  to  54  ...    . 

55  to  64  

65  to  74  

75  and  over.  . 

There  are  no  pronounced  differences  between  the  death  rates  of 
the  Industrial  experience  and  those  for  the  Kegistration  Area  of 
the  United  States  when  considered  by  sex  and  age  period.  The 
characteristics  above  described  are  observed  also  in  the  population 
data. 

The  death  rates  for  the  individual  years  between  1911  and  1916 
do  not  show  any  definite  tendency  toward  increase  or  decrease. 
The  figures  for  white  males  on  their  own  account  would  indicate  a 
condition  of  slight  increase;  for  white  females  there  is  very  little 
variation,  while  for  colored  males  there  is  a  slight  decrease.  The 
rates  for  colored  females  vary  too  markedly  from  year  to  year  to 
permit  any  conclusion  to  be  drawn.  The  facts  are  shown  m  the 
following  table: 

*  Stouman,  Knud,  "An  Analysis  of  Appendicitis  Statistics,"  American 
Journal  of  Public  Health,  Vol.  6,  July,  1916. 


HERNIA  AND  INTESTINAL  OBSTRUCTION. 


236 


TABLE  151. 
MORTALITY  FROM  APPENDICITIS,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Rates  per  100,000  Persons  Exposed.     Single  fears  in 
Period  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

11.8 

13.2 

10.2 

13.9 

12.8 

1916.. 

12.3 
11.8 
12.0 
12.0 
11.5 
10.9 

14.2 
13.3 
13.5 
13.7 
12.1 
12.2 

10.0 
10.1 
10.7 
10.1 
10.6 
9.6 

13.1 
15.6 
12.1 
13.5 
14.7 
14.1 

16.8 
11.7 
12.5 
14.3 
11.6 
9.7 

1915  

1914  

1913  

1912  

1911  

HERNIA  AND  INTESTINAL  OBSTRUCTION. 

Hernia  and  intestinal  obstruction  caused  5,519  deaths  among 
Metropolitan  policyholders  during  the  period  1911  to  1916.  The 
death  rate  was  10.3  per  100,000  exposed.  Of  these  deaths,  2,357 
were  caused  by  hernia  with  a  rate  of  4.4  and  3,162  by  intestinal 
obstruction  with  a  rate  of  5.9. 

Color,  Sex  and  Age  Incidence. 

Considering  the  conditions  jointly,  the  mortality  is  found  to  be 
higher  among  colored  policyholders  than  among  white  policyhold- 
ers; the  death  rate  for  colored  males  is  12.4  per  100,000  exposed, 
as  compared  with  8.5  for  white  males;  that  for  colored  females  is 
12.2  as  compared  with  11.2  for  white  females.  Among  white  poli- 
cyholders the  mortality  among  females  is  higher  than  that  among 
males.  The  highest  rates  occur  among  the  higher  age  groups,  the 
maximum  being  for  the  period  75  years  and  over.  It  is  significant 
that  the  rate  for  the  lowest  age  period,  1  to  4  years,  is  higher  than 
the  rates  for  the  succeeding  age  periods  up  to  age  35.  There  is 
considerable  difference,  however,  in  the  color  incidence  of  the  dis- 
ease in  the  different  age  groups.  Among  white  males,  the  rates 
for  the  first  five  age  periods,  that  is,  up  to  age  24,  are  higher  than 
the  corresponding  rates  for  females.  In  the  periods  from  25  to  74 
years  the  males  have  decidedly  lower  rates.  For  ages  75  and  over 
the  male  rate  is  a^ain  in  excess  of  the  female  rate.  Colored  males 


236 


MORTALITY   STATISTICS   OF    INSURED    WAGE    EARNERS. 


show  rates  in  excess  of  those  for  colored  females  for  the  first  four 
age  periods,  from  1  to  20  years.  From  24  to  54  years  the  female 
rates  are  higher.  For  the  age  period  55  to  64  and  65  to  74,  the 
male  rate  is  about  double  that  for  females ;  while  for  the  group  75 
years  and  over  the  male  rate  is  about  four  times  the  female  rate. 
These  facts  are  presented  in  the  following  table : 

TABLE  152. 

MORTALITY  FROM   HERNIA  AND  INTESTINAL  OBSTRUCTION,  CLASSIFIED  BT 

COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.      Industrial  Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

10.3 

8.5 

11.2 

12.4 

12.2 

1  to  4  

7.7 
2.3 
1.5 
2.3 
3.2 
5.4 
10.2 
20.6 
40.4 
75.5 
145.0 

9.6 

2.6 
2.0 
2.4 
3.4 
4.3 
7.0 
17.9 
34.7 
70.9 
160.3 

5.6 
1.6 
.9 
1.6 
2.5 
4.6 
10.9 
22.4 
44.7 
81.9 
141.5 

9.6 
5.2 
3.2 
5.8 
4.9 
8.0 
10.2 
17.9 
51.0 
83.5 
205.8 

8.9 
2.9 
1.6 
4.4 
5.0 
11.8 
16.8 
21.2 
28.2 
41.1 
45.4 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

Trend  of  the  Death  Rate  from  Hernia  and  Intestinal  Obstruction. 

The  general  tendency  during  the  period  has  been  toward  a  lower 
death  rate  from  these  causes.  The  highest  rate  was  that  for  1911 
(11.0),  the  lowest  that  for  1915  (9.6).  The  rate  increased  in  1916 
to  10.1.  Compared  with  the  experience  in  the  Registration  Area 
it  will  be  noted  that  the  rates  for  the  two  conditions  combined  were 
higher  for  each  year  in  the  Registration  Area  than  for  the  Indus- 
trial policyholders  of  the  Company.  A  closer  analysis,  however, 
shows  that  this  was  due  to  a  much  higher  mortality  in  the  Area 
for  intestinal  obstruction,  which  is  common  among  children  under 
one  year  of  age.  Since  there  are  no  Industrial  policyholders  at 
this  earliest  age  period,  the  rate  for  the  Company's  experience  is 
not  affected  by  this  high  mortality  from  intestinal  obstruction. 


SYPHILIS.  237 

SYPHILIS. 

Syphilis  as  the  chief  and  determining  cause  of  death  was  returned 
in  4,659  cases  in  the  Industrial  experience  of  the  Metropolitan  Life 
Insurance  Company  during  the  six  year  period  1911  to  1916.  This 
figure  corresponds  to  a  death  rate  of  8.7  per  100,000  living. 

In  common  with  other  statistical  returns  on  this  condition,  these 
figures  represent  an  utterly  inadequate  measure  of  its  true  inci- 
dence. In  fact,  the  statistical  discussion  of  the  mortality  from 
syphilis  is  still  subject  to  the  gravest  reservations  because  of  the 
tendency  of  physicians  to  conceal  this  disease  in  their  reports  of 
causes  of  death.  A  wide  gap  separates  the  meager  returns  of  mor- 
tality compilations  from  what  clinicians  know  to  be  the  wide  dis- 
tribution and  the  serious  consequences  of  syphilitic  infection. 
Nevertheless,  the  data  at  our  disposal  are  worthy  of  consideration, 
if  only  because  they  show  an  unmistakable  tendency  in  the  direc- 
tion of  more  accurate  certification  of  this  cause  of  death.  A  com- 
parison of  the  rate  for  the  year  1916  in  this  Industrial  experience 
with  that  for  1911  would,  in  itself,  indicate  a  most  alarming  in- 
crease. Thus,  in  the  first  year,  the  figure  is  3.4  per  100,000  and, 
in  the  last  year,  11.9.  The  apparent  rate  has  more  than  trebled 
in  the  short  period  of  six  years.  The  truth  is,  however,  that  each 
year  more  effort  was  expended  in  identifying  suspicious  reports  as 
true  cases  of  syphilis.  For  years  to  come,  the  published  death  rates 
for  syphilis  are  certain  to  increase;  but  many  years  will  elapse  be- 
fore the  mortality  figures  will  present  an  approximate  picture  of 
the  ravages  of  this  disease. 

Fundamentally,  the  statistics  of  syphilis  suffer  from  a  defect  in 
the  system  of  classification.  Conditions  clinically  known  as  due  to 
syphilis,  such  as  locomotor  ataxia,  general  paralysis  of  the  insane, 
and  certain  cardiovascular,  renal  and  hepatic  affections  can  not,  as 
yet,  be  assigned  to  this  cause  because  of  the  prevailing  rules  of 
international  compiling  practice.  For  the  time  being  and  until 
the  International  List  of  Causes  of  Death  is  revised,  these  diseases 
must  continue  to  be  assigned  to  conditions  of  various  local  tracts, 
and  not  to  the  general  disease,  syphilis,  which  classification  present 
medical  knowledge  demands.  Combining  syphilis,  locomotor  ataxia 
and  general  paralysis  of  the  insane,  there  would  be  not  4,659  deaths 
from  syphilis  in  this  experience,  but  a  total  of  7,680.  The  com- 
bined death  rate  is  thus  raised  to  14.3  per  100,000;  but  even  this 


238 


MORTALITY  STATISTICS  OF  INSURED  WAGE  EARNERS. 


figure  is  far  from.fhe  truth  when  we  consider  the  large  number  of 
fatal  cases  of  true  syphilis  which  are  reported  as  due  to  cirrhosis 
of  the  liver,  aneurism,  myelitis,  cerebral  tumor,  and  others.  It  is 
hoped  that  the  future  will  clear  up  the  uncertainty  and  indefinite- 
ness  which  still  affect  our  statistical  knowledge  of  syphilis  mor- 
tality. 

The  following  tables  show  first,  the  mortality  incidence  by  color 
and  sex  of  syphilis,  definitely  so  reported  or  identified,  and  second, 
for  the  group — syphilis,  locomotor  ataxia  and  general  paralysis  of 
the  insane  combined.  Distinction  is  made  for  the  individual  years 
between  1911  and  1916  in  both  tables. 

TABLE  153. 

MORTALITY  FBOM  SYPHILIS,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.    Single  Years  in 

Period  1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persons. 

White. 

Colored. 

Mates. 

Females. 

Males. 

Females. 

1911  to  1916  

8.7 

9.3 

3.9 

32.4 

18.7 

1916      

11.9 
11.4 
9.8 
6.0 
8.1 
3.4 

13.2 
12.2 
10.8 
5.9 
8.8 
3.0 

5.2 
54 
4.2 
2.7 
3.8 
1.5 

47.1 
44.8 
37.8 
21.5 
25.3 
13.9 

24.6 
22.4 
20.2 
16.1 
18.2 
9.5 

1915  

1914  

1913  

1912  

1911  

TABLE  154. 

MORTALITY  FROM  SYPHILIS,  LOCOMOTOR  ATAXIA  AND  GENERAL  PARALYSIS  or 
THE  INSANE,  COMBINED,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.    Single  Tears  in 

Period  1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

14.3 

16.6 

7.3 

43.3 

25.2 

1916    

15.7 
16.0 
14.6 
13.7 
13.7 
11.0 

17.7 
17.9 
16.9 
16.5 
16.2 
13.8 

7.6 
8.5 
7.2 
6.9 
7.4 
6.1 

55.3 
55.0 
47.8 
37.0 
35.3 
25.9 

30.6 
27.1 
26.7 
25.4 
24.6 
15.7 

1915      

1914  

1913     

1912       

1911  

SYPHILIS. 


239 


Even  these  tables,  defective  as  they  undoubtedly  are,  serve  to 
indicate  some  important  relations  (of  syphilis  mortality)  in  the 
several  color  and  sex  classes.  The  death  rate  among  colored  lives 
is  consistently  higher  than  among  whites.  The  rates  are  about 
three  to  one.  The  rates  are  much  higher  for  males  than  for  females 
in  each  one  of  the  color  groups.  If  we  consider  the  figures  for 
1916,  we  will  find  a  death  rate  of  55.3  for  all  ages  combined  for 
colored  males.  This  is  a  mortality,  figure  which  must  be  consid- 
ered seriously,  because  it  is  higher  than  the  rate  for  many  other 
causes  of  death  which  are  viewed  with  much  alarm.  More  inter- 
esting relations,  however,  are  brought  out  in  the  two  following 
tables  which  give  the  death  rates  by  age  period  both  for  syphilis  so 
reported  or  identified,  and  for  syphilis  combined  with  locomotor 
ataxia  and  general  paralysis  of  the  insane. 

TABLE  155. 
MORTALITY  FROM  SYPHILIS,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Eaies  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

8.7 

9.3 

3.9 

32.4 

18.7 

1  to  4  

2.6 
.6 
.6 
1.3 
3.3 
10.2 
22.0 
24.1 
20.1 
15.3 
13.0 

2.0 
.5 
.6 
.7 
2.6 
10.4 
29.8 
34.9 
28.5 
21.0 
22.7 

1.4 
.4 
.3 
.9 
1.6 
4.2 
9.0 
10.1 
8.3 
7.0 
4.2 

12.8 
2.3 
3.2 
4.2 
11.8 
35.2 
60.8 
71.0 
74.4 
60.1 
54.9 

14.6 
2.6 
1.6 
7.0 
12.4 
21.3 
31.3 
33.0 
26.8 
24.7 
18.1 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

A  comparison  of  Tables  155  and  156  shows,  as  might  be  ex- 
pected, that  for  the  earlier  age  periods  no  significant  changes  in  the 
rates  are  caused  by  combining  deaths  reported  from  syphilis  with 
those  reported  as  due  to  locomotor  ataxia  and  general  paralysis  of 
the  insane.  In  the  age  groups  which  cover  middle  and  old  age, 
however,  the  death  rates  are  raised  very  materially  by  the  addition 
of  deaths  certified  as  due  to  these  other  causes  but  which  are  caused, 


240 


MORTALITY    STATISTICS   OF   INSURED   WAGE    EARNERS. 


TABLE  156. 

MORTALITY  FROM  SYPHILIS,  LOCOMOTOR  ATAXIA  AND  GENERAL  PARALYSIS  or 

THE  INSANE,  COMBINED,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

14.3 

16.6 

7.3 

43.3 

25.2 

1  to  4     

2.6 
.7 
.7 
1.4 
3.5 
12.6 
32.9 
41.6 
43.6 
49.8 
74.9 

2.0 
.6 

.7 
.9 
2.7 
13.8 
48.2 
65.0 
64.0 
65.1 
112.1 

1.4 
.4 
.4 
1.0 
1.7 
5.5 
14.2 
18.2 
21.7 
32.2 
51.9 

12.8 
2.3 
3.2 
4.8 
12.5 
38.9 
79.8 
102.9 
117.1 
120.3 
137.2 

14.6 
2.6 
1.6 
7.0 
12.4 
24.3 
40.6 
48.7 
51.9 
66.9 
45.4 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

primarily,  by  syphilitic  infection.  The  figures  for  the  first  age 
period,  1  to  4  years,  do  not  constitute  an  adequate  illustration  of 
the  well  known  fact  that  syphilis  causes  a  very  high  mortality  in 
early  childhood.  This  experience  does  not  cover  the  mortality  of 
the  first  year  of  life;  if  it  did  the  figures  would  be  many  times 
higher.  After  the  first  age  group  there  is  a  decrease,  but  beginning 
with  the  period  15  to  19  years  there  is  a  continuous  increase 
throughout  the  period  of  middle  and  old  age.  This  continuous 
increase  is  shown,  with  one  or  two  minor  exceptions,  for  both  males 
and  females  among  white  and  colored  policyholders.  Attention  is 
directed  to  the  extremely  high  figures  representing  the  mortality 
from  syphilis  among  colored  males  at  the  period  between  45  and 
65  years. 

No  reference  is  made  here  to  the  figures  for  the  Eegistration  Area 
because  of  the  dissimilarity  in  the  two  experiences  with  respect  to 
reporting  practice,  age  and  color  factors.  Syphilis  is  very  common 
as  a  cause  of  death  in  the  first  year  of  life  and  this  infant  mortality 
finds  no  place  in  the  insurance  experience.  The  situation  is  further 
complicated  by  the  uncertainty  of  the  returns  in  the  published  mor- 
tality figures  for  the  Registration  Area  and  nothing  can  be  gained 
by  further  comparison. 


CHRONIC   BRONCHITIS. 


241 


CHRONIC  BRONCHITIS. 

Chronic  bronchitis  caused  4,224  deaths  among  Metropolitan  In- 
dustrial policyholders  during  the  six-year  period  1911  to  1916;  the 
death  rate  per  100,000  living  was  7.9.  This  rate  is  much  higher 
than  that  for  acute  bronchitis  in  the  same  experience,  which  is  con- 
trary to  the  condition  found  in  the  expanding  Registration  Area  of 
the  United  States.  The  difference  is  clearly  due  to  the  differing 
age  distribution  of  the  two  populations. 

The  disease  has  a  marked  color,  sex  and  age  incidence.  The 
rates  among  colored  persons  are  higher  than  among  the  white 
group  for  each  of  the  two  sexes.  The  highest  mortality  is  attained 
in  the  latest  age  periods  in  this  series,  namely,  65  years  and  over, 
although  the  rates  between  55  and  64  years  are  also  significant. 
Unlike  acute  bronchitis,  there  is  no  high  mortality  in  the  earliest 
age  periods  of  life.  It  is  noteworthy  also  that  the  excess  pointed 
out  for  colored  lives  does  not  continue  into  the  advanced  ages. 
From  age  65  onward,  the  rates  for  white  males  and  females  are 
much  in  excess.  It  is  not  clear  just  what  this  reversal  of  the  inci- 
dence in  the  two  races  indicates. 

The  following  table  presents  the  facts  for  chronic  bronchitis  by 
color,  sex  and  age : 

TABLE  157. 

MORTALITY  FROM  CHRONIC  BRONCHITIS,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over      

7.9 

6.8 

8.1 

9.4 

11.4 

1  to  4   

1.7 
.9 
.5 
.9 
1.7 
2.4 
3.6 
9.1 
29.5 
113.2 
304.4 

1.4 
.7 
.2 
.3 
1.1 
1.7 
4.0 
10.8 
32.1 
111.4 
309.3 

1.2 
.8 
.4 
.5 
.6 
1.2 
2.3 
6.6 
27.3 
120.3 
317.3 

6.4 
1.9 
2.2 
2.9 
5.3 
7.0 
6.2 
17.9 
28.2 
85.2 
150.9 

7.6 
3.2 
1.9 
7.3 
9.5 
7.9 
7.3 
11.3 
34.3 
82.2 
235.9 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

17 


242          MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 

As  in  the  case  of  acute  bronchitis,  we  are  not  justified  in  compar- 
ing the  above  figures  with  those  for  the  expanding  Registration  Area 
of  the  United  States.  The  rates,  as  we  have  seen,  are  important 
only  after  age  65,  and  it  is  at  these  ages  that  the  proportion  of 
policyholders  to  total  persons  insured  is  much  lower  than  in  the 
general  population. 

There  has  been  a  marked  decline  in  the  death  rate  in  the  insur- 
ance experience  from  chronic  bronchitis  since  1911  in  each  one  of 
the  color  and  sex  classes.  The  same  condition  is  to  be  observed 
in  the  figures  for  the  expanding  Registration  Area.  It  is  probable 
that  the  same  cause  has  been  at  work  to  bring  about  this  result, 
namely,  improved  reporting  of  causes  of  death  by  physicians. 
Many  vital  statistics  offices  in  the  country  have  for  a  number  of 
years  made  a  special  effort  to  advise  physicians  against  the  use  of 
the  term  "chronic  bronchitis"  when  tuberculous  bronchitis  was 
meant.  Undoubtedly  the  effect  of  this  effort  is  shown  in  the  rap- 
idly reducing  figures  for  this  cause  of  death. 

RHEUMATISM. 

Deaths  from  rheumatism  are  classified,  according  to  the  detailed 
International  List  of  Causes  of  Death,  under  two  distinct  headings. 
The  first  is  acute  articular  rheumatism  and  the  second  chronic 
rheumatism  and  gout.  Unfortunately  so  many  deaths  are  still  re- 
ported as  due  to  "  rheumatism,"  without  any  qualification,  that  it  is 
impracticable  to  determine  which  of  these  two  conditions  actually 
caused  the  deaths.  The  report  of  "rheumatism"  is  frequently 
made  in  cases  where  the  deaths  were  due  to  the  acute  infection, 
rheumatic  fever,  a  disease  which  has  epidemic  prevalence.  This  is 
the  condition  which  the  present  title  No.  47  of  the  International 
List  (acute  articular  rheumatism)  was  intended  to  cover.  Unfor- 
tunately, however,  the  same  term  "rheumatism"  is  also  returned 
for  many  cases  of  arthritis  deformans,  which  is  a  disease  of  the 
joints  of  doubtful  etiology,  but  which  ordinarily  pursues  a  chronic 
course.  It  is  also  used  in  cases  in  which  physicians  intended  it 
as  the  equivalent  of  "chronic  rheumatism,"  a  term  used  loosely 
for  all  sorts  of  long  standing  painful  conditions  of  the  joints, 
nerves,  bones  and  other  parts  of  the  body.  Any  attempt  at  this 
time  to  show  separately  the  mortality  actually  due  to  acute  rheu- 
matic fever  on  the  one  hand  and  to  chronic  rheumatoid  arthritis 


RHEUMATISM. 


243 


and  to  gout,  on  the  other  must,  therefore,  necessarily  fail  under 
present  conditions  of  reporting  and  tabulation. 

This  conclusion  is  fully  demonstrated  by  an  analysis  of  the  age 
distribution  of  the  deaths  charged  to  acute  articular  rheumatism 
in  the  Metropolitan  experience  during  the  period  1911  to  1916. 
There  were  3,409  deaths  assigned  to  acute  articular  rheumatism 
during  this  six-year  period,  of  which  1,023,  or  30  per  cent.,  were 
those  of  persons  over  45  years  of  age.  When  these  figures  are  con- 
sidered in  connection  with  the  fact  that  young  adults  are  the  ones 
principally  affected  by  rheumatic  fever  and  that  considerably  less 
than  10  per  cent,  of  the  cases,  based  on  authentic  experience,  might 
be  expected  to  affect  those  over  45  years  of  age,  it  is  readily  seen 
that  it  is  very  improbable  indeed  that  the  majority  of  these  deaths 
in  the  higher  age  periods  are  correctly  classified.  This  condition 
is  even  more  pronounced  in  the  reports  of  the  general  population, 
for  according  to  the  annual  mortality  report  of  the  Census  Bureau 
for  1915,  out  of  3,274  deaths  charged  to  acute  articular  rheuma- 
tism, 1,383  or  42.2  per  cent,  were  those  of  persons  over  45  years  of 
age.  This  is  contrary  to  clinical  experience. 

TABLE  158. 
MORTALITY  PROM  RHEUMATISM  (ACUTE  AND  CHRONIC),  CLASSIFIED  BY 

COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over        

7.4 

6.8 

7.2 

9.4 

11.3 

1  to  4  

2.8 
7.9 
7.6 
5.5 
4.0 
4.4 
5.8 
9.4 
16.3 
35.5 
57.6 

3.3 
8.0 
6.8 
5.7 
3.6 
4.0 
5.8 
9.8 
13.7 
28.3 
41.1 

2.4 
8.2 
8.8 
5.1 
3.9 
3.9 
4.3 
7.2 
14.8 
35.5 
56.9 

3.8 

5.5 
5.1 
5.1 
6.2 
5.0 
10.2 
15.6 
26.4 
41.8 
178.4 

1.3 
5.8 
7.1 
7.0 
5.5 
7.4 
9.9 
16.2 
30.8 
71.6 
90.7 

5  to  9   

10  to  14  

15  to  19   

20  to  24   

25  to  34   

35  to  44   

45  to  54   

55  to  64    

65  to  74    

75  and  over.  . 

In  this  discussion,  for  the  reasons  noted  above,  it  has  been  decided 
to  combine  the  two  International  List  titles  and  to  consider  them 


244 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


as  one  statistically  with  the  full  knowledge  that  different  clinical 
entities  are  included.  Only  the  future  will  determine  what  the 
true  incidence  of  these  separate  diseases  is. 

The  number  of  deaths  from  these  two  diseases  combined  among 
Metropolitan  Industrial  policyholders  during  the  period  1911  to 
1916  was  4,007  and  the  death  rate  was  7.4  per  100,000  exposed. 
Of  these  deaths  3,409  were  classified  under  "  acute  articular  rheu- 
matism "  with  a  corresponding  death  rate  of  6.3 ;  598  deaths,  with 
a  rate  of  1.1,  were  charged  to  "chronic  rheumatism  and  gout." 
Of  the  598  deaths  charged  to  the  latter,  502  or  83.9  per  cent,  were 
those  of  persons  over  45  years  of  age. 

"  Rheumatism,"  analyzed  in  this  way,  shows  a  higher  death  rate 
for  females  than  for  males  among  both  white  and  colored  policy- 
holders;  it  shows  quite  a  pronounced  excess  in  the  death  rate  of 
colored  persons  over  whites.  This  same  excess  is  also  exhibited  in 
the  reports  for  the  general  population.  The  higher  death  rates  for 
the  females,  however,  are  in  evidence  chiefly  during  the  three  high- 
est age  periods,  and  it  will  be  observed  that  during  the  chief  wage- 
earning  periods,  among  white  policyholders  at  least,  the  death  rates 
for  the  males  are  somewhat  greater.  The  table  on  page  213  pre- 
sents the  mortality  during  the  period  1911  to  1916  among  Metro- 
politan Industrial  policyholders  by  color,  sex,  and  age. 

TABLE  159. 
MORTALITY  FROM  RHEUMATISM  (ACUTE  AND  CHRONIC),  CLASSIFIED  BY 

COLOR  AND  BY  SEX. 
Death  Sates  per  100,000  Persons  Exposed.    Single  Tears  in 

Period  1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

7.4 

6.8 

7.2 

9.4 

11.3 

1916.. 

5.9 
6.9 
7.3 
7.8 
8.2 
8.9 

6.2 

6.5 
6.4 
7.2 
7.3 

7.7 

5.6 
6.8 
7.2 
7.4 
7.8 
8.9 

6.4 
7.5 
9.4 
9.7 
14.1 
9.6 

7.8 
10.1 
11.2 
12.4 
11.6 
15.3 

1915  

1914      .    . 

1913  

1912  

1911  

The  general  trend  of  the  mortality  charged  to  these  diseases  is 
downward,  the  maximum  for  the  period  1911  to  1916  among  the 


ACUTE   BRONCHITIS.  245 

insured  having  been  the  rate  of  8.9  per  100,000  exposed  in  1911 
and  the  minimum,  that  of  5.9  in  1916.  A  continuous  decrease  is 
shown  throughout  the  intervening  years.  This  downward  tendency 
is  observed  for  both  white  and  colored  policyholders.  Table  159 
shows  the  trend  of  the  mortality  from  "acute  articular  rheuma- 
tism" and  "chronic  rheumatism  and  gout"  combined  during  the 
period  1911  to  1916. 

ACUTE  BRONCHITIS. 

There  were  2,636  deaths  among  Metropolitan  Industrial  policy- 
holders  from  acute  bronchitis  during  the  six-year  period  1911  to 
1916.  This  corresponds  to  a  death  rate  of  4.9  per  100,000  living. 

The  deaths  are  concentrated  at  the  two  extremes  of  life,  that  is, 
under  age  5  and  over  age  65.  Taking  the  experience  as  a  whole,  70 
per  cent,  of  all  the  deaths  from  acute  bronchitis  are  found  in  these 
age  periods.  During  the  remaining  years  of  life  the  deaths  are  so 
few  as  hardly  to  justify  any  particular  comment. 

The  death  rate  from  acute  bronchitis  is  considerably  higher 
among  colored  than  among  white  persons;  the  rate  for  females  in 
each  group  is  higher  than  for  males.  The  highest  rate  in  the  total 
experience  is  found  in  the  age  group  75  years  and  over,  100.4  per 
100,000.  The  next  highest  rate  is  in  the  period  65  to  74  years, 
31.9  per  100,000.  The  age  period  1  to  4  years  follows  with  a  rate 
of  27.0.  These  age  characteristics,  however,  are  very  different 
when  we  consider  the  white  and  colored  races.  Among  colored 
males  and  females,  about  one-half  the  deaths  from  acute  bronchitis 
are  found  in  the  period  1  to  4  years ;  this  results  in  very  high  death 
rates  for  this  early  period  of  life ;  in  fact,  the  rate  for  colored  males 
was  over  two  and  one-half  times  that  for  white  males  and  that  for 
colored  females  three  and  one-third  times  the  rate  for  white  females. 

The  table  on  page  246  presents  the  facts  by  age  period  and  for 
each  sex  and  color  group. 

It  is  impossible  to  make  a  fair  comparison  between  the  death  rates 
referred  to  above  and  those  for  the  expanding  Registration  Area 
of  the  United  States.  The  reason  is  that  acute  bronchitis  is  a  dis- 
ease which  causes  death  chiefly  in  infancy  and  old  age  but  more 
especially  in  early  infancy.  In  the  Registration  Area  over  one- 
half  of  the  deaths  charged  to  this  disease  are  of  infants  under  one 
year  of  age  and  a  very  considerable  number  relate  to  persons  over 


246 


MORTALITY    STM'ISTICS   OF   INSURED   WAGE   EARNERS. 


TABLE  160. 
MORTALITY  FROM  ACUTE  BRONCHITIS,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Rates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Male*. 

Female*. 

M&lM. 

Female*. 

All  ages  —  one  and 
over  

4.9 

4.4 

4.8 

6.4 

7.5 

1  to  4  

27.0 
2.0 
.5 
.6 
.6 
1.0 
1.5 
2.3 
8.1 
31.9 
100.4 

23.5 
1.9 
.5 
.3 
.4 
.7 
1.3 
3.0 
8.0 
26.8 
68.1 

23.9 
1.7 
.2 
.4 
.4 
.4 
.9 
1.7 
8.7 
37.4 
123.1 

62.8 
1.9 
2.2 
1.0 
2.6 
3.4 
3.8 
4.2 
6.6 
8.4 
68.6 

80.0 
5.1 
2.5 
4.1 
2.1 
2.8 
3.4 
2.6 
5.7 
29.4 
81.7 

5  to  9   

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44   

45  to  54   

55  to  64   .... 

65  to  74  

75  and  over  .  . 

70  years  of  age.  In  the  first  of  these  age  groups  there  are  no  Metro- 
politan policyholders  at  all,  and  for  persons  over  70  a  far  smaller 
proportion  of  Industrial  policyholders  were  observed  than  were  esti- 
mated to  be  in  the  general  population.  It  is,  therefore,  not  at  all 
surprising  that  the  crude  rate  for  acute  bronchitis  in  the  general 
population  is  very  much  higher  than  that  for  the  Industrial  expe- 
rience but  no  significance  can  possibly  be  attached  to  these  dif- 
ferences. 

There  have  been  slight  and  unimportant  changes  in  the  death 
rate  in  the  Industrial  experience  in  the  period  between  1911  and 
1916. 

ALCOHOLISM,  ACUTE  OR  CHRONIC. 

There  were  2,555  deaths  among  Metropolitan  Industrial  policy- 
holders  during  the  period  1911  to  1916,  which,  on  the  basis  of 
descriptions  of  causes  of  death  on  death  claims,  were  classified  as 
due  to  alcoholism.  The  death  rate  was  4.7  per  100,000  exposed. 
There  were  no  marked  variations  in  the  mortality,  as  compiled, 
during  the  six-year  period,  the  maximum  rate  for  the  period  being 
that  for  1912  (5.3)  and  the  minimum  for  the  year  1911  (4.0). 
Compared  year  by  year  with  the  death  rates  for  the  expanding  Eeg- 
istration  Area,  it  will  be  noted  that  those  for  the  latter  were,  in 


ALCOHOLISM,  ACUTE  OB  CHRONIC. 


247 


general,  a  little  higher  than  those  for  the  policyholders,  the  single 
exception  being  the  year  1912  when  the  rate  was  the  same  for  each 
experience  (5.3). 

Color,  Sex,  and  Age  Incidence. 

The  death  rate  per  100,000  for  white  males  (8.8)  was  higher 
than  for  colored  males  (6.8)  and  that  for  white  females  (1.6)  was 
slightly  in  excess  of  the  rate  for  colored  females  (1.5).  The 
heaviest  mortality  was  registered  in  the  age  period  35  to  44  years 
(14.2  per  100,000  exposed),  with  a  rate  in  the  following  age 
period,  45  to  54  years,  but  slightly  less  (13.9  per  100,000).  In 
these  two  age  groups  occurred  1,529  deaths  or  59.8  per  cent,  of 
all  the  deaths  reported  from  this  cause  among  the  insured  group. 
Considerably  more  than  half  of  the  mortality  from  this  cause 
occurs,  year  after  year,  in  the  experience  of  the  expanding  Kegis- 
tration  Area  between  the  ages  of  35  and  55  years.  The  mortality 
under  25  years  of  age  from  alcoholism  is  negligible.  For  white 
males  the  rate  for  the  period  45  to  54  years  is  slightly  higher  than 
in  the  preceding  period;  for  white  females  and  for  colored  persons 
of  each  sex  the  rate  at  this  period  is  either  slightly  lower  than  or 
identical  with  that  for  the  preceding  period.  After  age  54,  how- 
ever, there  is  a  uniform  decline.  The  following  table  gives  the 
rates  per  100,000  exposed  by  color,  sex,  and  by  age  period: 

TABLE  161. 
MORTALITY  FROM  ALCOHOLISM,  CLASSIFIED  BY  COLOR, SEX  AND  BY  AGE  PERIOD. 

Death  Eates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males.      1        Females. 

All  ages  —  one  and 
over  

4.7 

8.8 

1.6 

6.8 

1.5 

1  to  19   

.1 
1.0 

6.2 
14.2 
13.9 
10.2 
8.4 
4.8 

1.7 
12.8 
32.2 
32.4 
24.0 
18.4 
12.8 

.3 
2.4 
4.7 
4.1 
2.2 
2.3 

.3 

1.6 
6.0 
16.6 
14.7 
13.8 
16.7 
13.7 

.4 
1.1 
1.5 
3.1 
3.1 
1.3 

20  to  24   

25  to  34    

35  to  44   

45  to  54  

55  to  64  .. 

65  to  74   . 

75  and  over.  . 

f  Less  than  .05  per  100,000  exposed. 


248          MORTALITY   STATISTICS   OF   INSURED  WAGE   EARNERS. 

Unreliability  of  the  Data  for  Alcoholism. 

Published  reports  of  deaths  and  death  rates  for  alcoholism  are 
not  regarded  seriously  by  those  who  compile  them.  The  difficulties 
which  beset  the  path  of  the  vital  statistician  in  obtaining  figures 
covering  mortality  from  this  condition  are  many  and  serious.  The 
same  trouble  is  encountered  as  is  found  in  dealing  with  the  venereal 
diseases:  physicians  often  hesitate  and,  in  fact,  wilfully  refuse  to 
write  on  death  certificates  the  name  of  the  primary  cause  of  death 
when  such  cause  is  one  which  might  cast  a  certain  degree  of  odium 
on  the  family  of  the  deceased.  In  such  diseases  as  this  many  phy- 
sicians reason  that  if  they  cannot  comply  with  the  requirement  of 
the  law  and  at  the  same  time  have  what  they  consider  due  regard 
for  the  confidence  of  patients  and  the  positions  of  their  families, 
they  will  disregard  the  spirit  of  the  law  and  report  as  causes  of 
death  terminal  or  complicating  conditions  rather  than  primary 
causes.  There  is  little  question  that  each  year  thousands  of  deaths 
occur  in  which  alcoholism  was  a  factor  but  which  are  never  re- 
turned as  due  to  this  cause.  Many  of  the  deaths  reported  as  due 
to  "  cirrhosis  of  the  liver  "  are  deaths  of  which  alcoholism  was  the 
primary  and  causative  factor.  Many  that  are  ascribed  to  "  menin- 
gitis" are  caused  by  that  variety  known  as  alcoholic  serous  menin- 
gitis. Many  reported  as  caused  by  "apoplexy"  or  "cerebral 
edema  "  are  in  reality  cases  of  alcoholic  cerebral  apoplexy  or  alco- 
holic cerebral  edema,  or  what  is  commonly  known  as  alcoholic  "  wet 
brain." 

The  death  rates  in  the  table  on  page  247  are  not  presented, 
therefore,  as  figures  representing  the  actual  or  approximate  mor- 
tality from  alcoholism  among  the  Company's  Industrial  policy- 
holders.  They  represent  reported  conditions — not  actual  condi- 
tions. The  rates  would  be  much  lower  than  they  are  if  it  were  not 
for  the  fact  that  special  inquiries  by  the  Statistical  Bureau  have 
brought  out  the  fact  of  the  existence  of  alcoholism  in  many  cases 
where  no  mention  of  it  was  made  by  the  physicians  in  their  state- 
ments to  the  Company  or  on  certified  copies  of  the  death  certifi- 
cates. Many  years  will  elapse  before  even  approximate  death  rates 
covering  the  mortality  from  this  disease  can  be  presented  by  any 
statistical  office. 


CHAPTER  XVI. 

This  chapter  will  deal  with  the  following  diseases : 

(1)  Pellagra. 

(2)  Malaria. 

(3)  Angina  Pectoris. 

(4)  Ulcer  of  Stomach. 

(5)  Acute  Poliomyelitis. 

PELLAGRA. 

The  facts  for  pellagra  mortality  in  this  investigation  of  insured 
wage  earners  are  of  special  importance,  first,  because  the  areas  rep- 
resented in  this  inquiry  cover  a  large  part  of  the  region  of  pellagra 
incidence  in  the  United  States,  and  second,  because  the  figures  refer 
to  the  wage  earning  group  of  the  population  among  whom  pellagra 
is  more  prevalent  than  in  populations  generally.  Furthermore, 
adequate  data  on  the  race  or  color,  sex  and  age  incidence,  in  rela- 
tion to  persons  exposed,  are  also  available  from  this  study  and  these 
may  aid  the  laboratory  and  clinical  experts  in  their  researches  into 
this  disease.  The  published  population  mortality  statistics  do  not, 
at  present,  offer  such  opportunities  for  the  detailed  examination 
of  pellagra  mortality.  The  table  on  page  250  gives  an  idea  of  the 
geographic  distribution  of  pellagra  in  the  several  districts  of  the 
South  and  Southwest  where  most  of  the  pellagra  deaths  in  this 
experience  were  recorded.  The  color  incidence  is  also  shown. 

It  will  be  observed  upon  comparison  of  the  following  table  with 
the  one  for  malaria  (shown  on  page  256)  that,  in  general,  where 
malaria  death  rates  are  high,  pellagra  death  rates  are  low.  This 
does  not,  of  course,  indicate  any  relation  between  the  two  diseases. 
It  does  emphasize  the  fact,  however,  that  the  chief  sanitary  problem 
of  the  coast,  gulf  and  river  plain  of  the  South  is  malaria  and  that 
of  the  Southern  Appalachian  Plateau,  supporting  a  considerable 
factory  population,  is  pellagra.  Malaria  and  pellagra  are  two  of 
the  outstanding  diseases  and  conditions  which  still  constitute  a 
serious  menace  to  the  efficiency  of  the  Southern  wage  earner — more 
so  for  the  negro  than  for  the  white  man.  Both  diseases,  when  of 

249 


260 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


TABLE  162. 
MORTALITY  FROM  PELLAGRA  IN  SELECTED  SOUTHERN  DISTRICTS. 

Classified  by  Color.    Years  1914,  1915  and  1916  Combined. 
Sates  per  100,000  Exposed. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Area  and  District. 


Rate  per  100.000. 


Whlt«. 


foloml. 


Entire  Metropolitan  Experience 3.3 

Southern  districts  combined 27.5 

Birmingham,  Ala 16.0 

Little  Rock,  Ark 16.5 

Atlanta,  Ga 68.8 

Augusta,  Ga 67.7 

Columbus,  Ga 176.6 

Macon,  Ga 102.3 

Savannah,  Ga 33.4 

New  Orleans,  La 5.4 

Poplar  Bluff.  Mo 11.4 

Charlotte,  N.  C 81.4 

Greensboro,  N.  C 53.1 

Raleigh,  N.  C 35.1 

Columbia,  S.  C 167.5 

Spartanburg,  S.  C 83.8 

Chattanooga,  Tenn 51.5 

Jackson,  Tenn 29.5 

Knoxville,  Tenn 68.8 

Memphis,  Tenn 22.3 

Nashville,  Tenn 41.4 

Richmond,  Va 24.2 

Roanoke,  Va 56.2 


17.9 


57.6 


28.7 

63.1 

106.0 

101.0 

293.9 

108.5 

70.4 

19.1 

8.7 

102.4 

98.1 

127.3 

167.9 

117.8 

57.5 

61.2 

56.8 

109.3 

40.3 

19.6 

52.3 


the  chronic  type,  involve  long  periods  of  disability  for  work  and  in 
certain  areas  of  intensive  incidence,  are  the  cause  of  heavy  pre- 
ventable mortality  at  the  productive  ages  of  life.  Among  the  white 
industrial  population  in  certain  sections  of  the  South,  malaria  and 
pellagra,  together,  often  assume  more  importance  as  causes  of  death 
than  does  tuberculosis. 

Before  drawing  any  conclusions  on  the  comparative  color,  sex 
and  age  incidence  of  the  disease  it  should  be  remarked  that  the 
exposure  upon  which  the  death  rates  reported  in  this  study  are 
based,  comprises  all  of  the  Company's  policyholders  in  the  United 
States  and  in  Canada.  A  very  large  proportion  of  this  exposure, 
therefore,  was  located  in  nonpellagrous  territory.  In  the  discus- 
sion of  malaria  it  will  be  remarked  that  20  per  cent,  of  the  Com- 
pany's total  exposure  to  risk  was  located  in  the  Southern  and 


PELLAGRA. 


251 


Southwestern  sections  of  the  country.  In  order  to  have  death  rates 
best  constituted  for  purposes  of  investigating  the  true  color,  sex 
and  age  incidence  of  the  disease  it  would  be  desirable  to  confine 
the  exposure  and  deaths  to  pellagrous  portions  of  the  country. 
This  is,  however,  quite  impracticable  at  the  present  time  both  for 
population  and  insurance  data.  The  rates  are  presented  with  this 
reservation  as  to  the  lack  of  homogeneity  in  the  geographic  areas 
of  the  exposures  and  of  the  deaths.  The  figures  have  considerable 
value,  nevertheless,  as  will  be  seen  in  the  following  table : 

TABLE  163. 
MORTALITY  FROM  PELLAGRA,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Eates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

4.3 

1.6 

3.9 

6.4 

20.7 

1  to  4  

.4 
.3 
.6 
.9 
2.8 
5.5 
8.9 
9.2 
13.0 
11.9 
10.1 

.2 

.2 
.3 
.3 
1.4 
2.9 
4.1 
10.9 
10.3 
9.9 

.5 
.2 
.5 
.9 
2.5 
4.8 
8.4 
8.1 
10.1 
8.8 
5.0 

2.3 
2.3 
2.7 
1.3 
2.3 
4.6 
8.8 
15.3 
19.2 
21.7 
41.2 

1.5 
3.5 
3.4 
6.2 
19.8 
24.5 
31.1 
30.9 
39.2 
41.1 
45.4 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

f  Less  than  .05  per  100,000  exposed. 

There  is  a  constantly  rising  death  rate  with  advancing  age.  The 
disease  has  its  lowest  incidence  as  a  cause  of  death  in  the  ages  of 
childhood.  In  fact,  the  number  of  deaths  of  white  children  under 
15  is  negligible;  colored  children  show  a  larger  number  of  cases. 
After  age  15,  the  rates  increase  regularly  with  age  until  the  age 
period  55  to  64  years  is  reached.  From  this  point  onward  the  rates 
fall  slightly  among  white  lives  but  continue  to  increase  among  the 
colored 

The  death  rate  among  colored  persons  is  higher  than  among 
white  persons.  This  is  true  at  every  age  period  and  for  both  sexes. 
In  fact,  the  rate  is  four  times  as  high  for  the  colored  males  as  for 
the  white  males,  all  ages  combined,  and  more  than  five  times  as 


252          MORTALITY   STATISTICS   OF   INSURED   WAGE   EARNERS. 

high  for  the  colored  females  as  for  the  white  females.  This  con- 
dition is  largely  the  result  of  the  different  geographic  distributions 
of  the  white  and  colored  policyholders.  The  latter  reside  for  the 
most  part  in  the  Southern  States  where  pellagra  is  common,  whereas 
the  majority  of  white  policyholders  reside  in  the  Northern  States 
where  pellagra  is  still  very  rare.  There  is,  nevertheless,  a  real 
excess  in  the  mortality  rate  among  the  colored  as  is  shown  by  the 
figures  in  the  first  table  of  this  section  for  a  number  of  representa- 
tive southern  cities  and  towns  where  pellagra  has  been  prevalent  for 
a  number  of  years. 

The  rate  for  females  is  higher  than  for  males  both  among;  the 
white  and  among  the  colored.  This  is  found  at  virtually  every  age 
period.  From  ages  25  to  54  years  the  pellagra  death  rate  of  white 
males  is  only  from  30  to  50  per  cent,  that  of  white  females.  Begin- 
ning with  the  age  period  55  to  64  years  and  continuing  to  the  end 
of  the  table,  white  males,  however,  show  a  higher  pellagra  mortality 
than  do  white  females.  Colored  males  at  all  age  periods  show 
lower  death  rates  for  pellagra  than  do  colored  females.  It  would 
be  very  interesting  to  learn  why  females  in  this  country  have  the 
higher  rates  since  no  such  relation  between  pellagra  death  rates  of 
the  sexes  has  been  observed  in  a  number  of  other  countries  where 
the  disease  is  prevalent. 

Comparison  of  Pellagra  Mortality  Among  Insured  White  Persons 

and  Among  the  General  Population  of  the  Expanding 

Registration  Area  of  the  United  States. 

A  comparison  of  pellagra  mortality  among  this  group  of  insured 
wage  earners  and  among  the  population  of  the  expanding  Regis- 
tration Area  in  the  United  States  is  possible  under  certain  limiting 
conditions.  It  must  be  remembered,  in  the  first  place,  that  the 
exposure  to  risk  in  the  insurance  experience  covers  a  very  much 
larger  proportion  of  persons  in  the  pellagrous  region  of  the  South 
and  Southwest  than  does  the  population  included  in  the  expanding 
Registration  Area  of  the  United  States.  This  fact  in  itself  would 
account  for  the  great  excess  in  pellagra  death  rates  of  insured  white 
persons.  Thus,  between  25  and  64  years  for  both  white  males  and 
white  females,  there  is,  practically,  a  constantly  rising  rate  of  excess 
in  the  pellagra  death  rate  of  insured  white  persons  over  the  rates  for 
the  general  population  of  the  Registration  Area.  The  excess  is 


PELLAGEA. 


253 


more  marked  for  insured  white  males  than  for  insured  white  females. 
In  view  of  the  difference  between  the  two  sets  of  data  as  to  geo- 
graphic area  and  as  to  the  social  status  of  persons  included  in  both 
experiences,  it  would  be  well  not  to  stress  comparison  of  the  figures 
too  far.  The  pellagra  mortality  experience  of  the  Registration 
Area,  1910  to  1915,  and  of  insured  white  persons,  1911  to  1916, 
according  to  sex  and  age  period  is  shown  comparatively  in  the  fol- 
lowing table: 

TABLE  164. 
MORTALITY  PROM  PELLAGRA. 

Death  Rates  per  100,000  Persons  Exposed.    Classified  by  Sex  and  Age  Periods. 
Insured  White  Lives  in  Experience  of  Metropolitan  Life  Insurance  Com- 
pany, Industrial  Department  (1911  to  1916)  and  General  Popula- 
tion of  Expanding  Registration  Area  of  the  United  States 
(1910  to  1915). 


Males. 

Females. 

Age  Period. 

M.  L.  I.  CO. 

U.  S.  Reg. 

Percentage 
M.  L.  I.  Co. 

M.  L.  I.  Co. 

U.  8.  Reg. 

Percentage 
M.  L.  I.  Co. 

(White). 

Area. 

of  Reg.  Area. 

(White). 

Area. 

of  Reg.  Area. 

All  ages  —  one 

and  over.  .  . 

1.6 

1.1 

145.5 

3.9 

2.8 

139.3 

1  to  4.. 

.2 

.2 

100.0 

.5 

.3 

166.7 

5  to  9.. 

t 

.3 

10.0 

.2 

.3 

66.7 

10  to  14. 

.2 

.2 

100.0 

.5 

.4 

125.0 

15  to  19. 

.3 

.2 

150.0 

.9 

1.0 

90.0 

20  to  24. 

.3 

.5 

60.0 

2.5 

2.4 

104.2 

25  to  34. 

1.4 

.9 

155.6 

4.8 

3.7 

129.7 

35  to  44. 

2.9 

1.4 

207.1 

8.4 

5.2 

161.5 

45  to  54. 

4.1 

2.3 

178.3 

8.1 

4.9 

165.3 

55  to  64. 

10.9 

3.8 

286.8 

10.1 

5.4 

187.0 

65  to  74. 

10.3 

3.8 

271.1 

8.8 

4.9 

179.6 

75  and  over 

9.9 

3.4 

291.2 

5.0 

3.7 

135.1 

fLess  than  .05  per  100,000  exposed. 

An  examination  of  the  above  table  will  show  some  interesting 
similarities  in  the  two  experiences.  In  the  first  place,  females  in 
both  cases  show  higher  rates  than  do  males;  there  are  only  a  few 
unimportant  exceptions.  Secondly,  the  rates  increase  with  ad- 
vancing age.  In  spite  of  their  differences,  therefore,  the  two  sets 
of  data  confirm  one  another  in  essential  respects.  If  they  do  not 
correspond  more  closely  in  actual  rates  it  is  because  they  refer  to 
different  geographic  areas.  The  above  conclusion  is  confirmed  by 
the  similar  distribution  of  the  deaths  from  pellagra  by  age  in  the 
two  experiences  as  is  shown  in  the  following  table : 


254 


MORTALITY   STATISTICS   OP    INSURED   WAGE   EABNER8. 


TABLE  165. 

NUMBER  AND  PERCENTAGE  DISTRIBUTION  OF  DEATHS  FROM  PELLAGRA. 
1911  TO  1915.    CLASSIFIED  BY  AGE  PERIOD. 

Insured  White  Lives  in  Experience  of  Metropolitan  Life  Insurance  Company, 

Industrial  Department,  and  General  Population  of  Expanding 

Registration  Area  of  the  United  States. 


A«e  Period. 

Metropolitan  Experience. 

U.  8.  Registration  Are*. 

No.  of  Deaths. 

Per  Cent,  of 
Total. 

No.  of  Deaths. 

Per  Cent,  of 
Total. 

All  ages  —  one  and  over 
1  to  14.. 

1942 

100.0 

6694* 

100.0 

74 

52 
136 
394 
453 
355 
340 
120 
18 

3.8 

2.7 
7.0 
20.3 
23.3 
18.3 
17.5 
6.2 
.9 

264 
193 
491 
1326 
1565 
1214 
947 
516 
178 

3.9 
2.9 

7.3 
19.8 
23.4 
18.1 
14.1 
7.7 
2.7 

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  

75  and  over  — 

*  Known  ages  only. 

The  two  distributions  are  much  alike.  It  is  only  after  age  55 
that  differences  make  themselves  felt  and  these  are  the  result  in  all 
probability  of  the  very  different  age  constitution  of  the  living  in 
the  two  groups;  the  proportion  of  policyholders  after  age  65  is 
very  much  lower  than  the  proportion  in  the  corresponding  age 
group  of  the  general  population.  For  the  ages  preceding  this 
period  of  life,  however,  there  is  virtual  correspondence. 

Trend  of  the  Death  Rate  from  Pellagra. 

The  death  rate  from  this  disease  may  be  expected  to  vary  accord- 
ing to  the  greater  or  less  intensity  of  the  factors  which  produce  the 
disease  in  the  first  place,  and  which  aggravate  the  disease  and  re- 
tard recovery  in  the  second  place.  It  has  been  fairly  well  estab- 
lished by  recent  research  work  of  the  U.  S.  Public  Health  Service 
that  pellagra  is  a  deficiency  disease,  the  result  of  a  persistent  ab- 
sence in  the  diet  of  meat,  eggs,  milk,  beans,  peas  and  other  proteins. 
The  every-day  diet  of  the  wage  earning  element  in  the  South  is 
characterized  by  this  deficiency  and  is  conditioned  primarily  by  the 
state  of  industry,  the  regularity  of  employment  and  the  wage-level. 
An  important  secondary  fact  not  to  be  overlooked,  however,  is  the 
general  status  of  some  parts  of  the  industrial  population  of  the 
South  as  regards  efficiency  in  personal  and  home  life,  and  whether 


PELLAGRA. 


255 


or  not  there  is  disregard  of  the  plain  facts  of  hygiene,  diet  and 
order  in  the  home. 

In  the  following  table  are  shown  the  facts  of  pellagra  mortality 
for  the  six  year  period  1911  to  1916,  distinguishing  single  calendar 
years : 

TABLE  166. 

MORTALITY  FROM  PELLAGRA,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.    Single  Years  in 
Period  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

4.3 

1.6 

3.9 

6.4 

20.7 

1916... 

3.6 
6.7 
5.3 
3.3 
2.8 
3.6 

1.4 
2.1 
2.2 
1.3 
1.2 
1.7 

2.7 
5.9 
4.7 
3.4 
2.6 
4.1 

6.2 
12.2 
6.9 
4.6 
4.1 
3.4 

22.4 
36.6 

26.7 
13.1 
12.5 
10.5 

1915  

1914  

1913  

1912  

1911  

The  possible  effect  of  economic  conditions  upon  the  incidence  of 
pellagra  may  be  seen  from  the  foregoing  data.  Late  in  1914  and 
in  1915,  when  the  economic  situation  in  the  South  was  exceedingly 
grave,  the  pellagra  mortality  rates  were  high.  In  1916,  following 
a  period  of  economic  revival,  characterized  by  an  extraordinary 
movement  of  raw  and  manufactured  cotton  products,  resulting  in 
prosperity  for  both  employers  and  wage  earners  alike,  the  pellagra 
death  rate  dropped  to  a  figure  of  3.6  per  100,000  exposed.  These 
economic  facts  affected  both  the  white  and  colored  groups  in  this 
experience,  and  likewise,  probably,  the  pellagra  death  rates  of  these 
groups. 

It  must  be  remembered  that  pellagra  manifests  itself  mainly  in 
two  clinical  forms,  an  acute  type  and  a  chronic  recurrent  form.  It 
is  probable  that  an  improvement  in  the  industrial  situation  which 
results  in  better  wages  and  regular  employment  and  consequently 
in  a  more  generous  family  diet  reduces  the  number  of  acute  cases 
and  that  it  modifies  the  severity  of  the  chronic  recurrent  form  of 
the  disease. 


256 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


MALARIA. 

No  infection,  except  perhaps  tuberculosis,  compares  with  malaria 
in  the  extent  of  its  geographic  distribution  or  in  its  importance  as 
a  cause  of  physical  disability  among  mankind  generally.  Fifty 
years  ago,  in  the  United  States,  malaria  seriously  affected  nearly 
every  state  then  fairly  thickly  populated.  Noteworthy  epidemics 
were  recorded  in  Michigan,  New  Jersey,  Pennsylvania  and  Massa- 
chusetts, as  well  as  in  the  South,  where  the  disease  still  lingers  as 
a  cause  of  considerable  and  preventable  loss.  The  advance  of  sani- 
tary engineering,  the  growth  of  populations  and  the  subsequent 
filling-in  of  swampy  areas  have  gradually  eliminated  the  breeding 
grounds  of  the  anopheles  mosquito  and  have  thus  almost  eradicated 
malaria  from  the  northern  tier  of  states.  The  very  largest  regis- 
tration of  malaria  in  this  mortality  experience  of  wage  earners  was 
drawn  from  the  group  of  persons  insured  in  the  southern  and 
southwestern  portions  of  the  United  States.  It  is  significant  to 

TABLE  167. 

MORTALITY  FROM  MALARIA  IN  SELECTED  SOUTHERN  DISTRICTS. 
Classified  by  Color.    Tears  1914,  1915  and  1916  Combined. 

Rates  per  100,000  Exposed. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Rate  per 

100.000. 

Area  and  Dtatrlct. 

White. 

Colored. 

Entire  Metropolitan  Experience  

1.4 

158 

Southern  districts  combined  

9.3 

41  6 

Birmingham,  Ala  

58 

359 

Little  Rock/Ark  

330 

1607 

Augusta,  Ga  

328 

34  5 

Columbus,  Ga  

125 

84  5 

Macon,  Ga  

28.5 

362 

Savannah,  Ga  

11.1 

1303 

Cairo,  111  

444 

542 

Paducah,  Ky  

54.6 

73.2 

New  Orleans,  La  

4.4 

36.4 

Poplar  Bluff,  Mo  

106.2 

609 

St.  Louis,  Mo  

20 

9.4 

Charlotte,  N.  C  

44 

465 

Raleigh,  N.  C  

15.4 

50.9 

Columbia,  S.  C  

17.8 

21.7 

Jackson.  Tenn  

51.6 

89.0 

Memphis,  Tenn  

33.5 

105.9 

Nashville,  Tenn  

2.5 

17.6 

MALARIA. 


257 


observe  also  that  most  of  these  malaria  deaths  occurred  in  the 
coastal,  gulf  and  river  plain  of  the  South  and  nominally  few  of  them 
on  the  Appalachian  Plateau.  The  table  on  page  256  shows  the  geo- 
graphic distribution  of  the  malaria  deaths  in  this  mortality  expe- 
rience for  the  combined  years  1914,  1915  and  1916,  the  only  three 
years  for  which  the  data  are  fully  available  with  respect  to  geo- 
graphic incidence. 

The  2,295  deaths  from  malaria  in  the  experience  of  the  six  year 
period  correspond  to  a  death  rate  of  4.3  per  100,000  persons  exposed. 
It  should  be  remembered  in  considering  this  rate  that  whereas  most 
of  these  deaths  from  malaria  came  from  territory  in  the  southern 
and  southwestern  sections  of  the  United  States,  the  exposure  upon 
which  the  death  rates  are  based  covers  all  of  the  Company's  policy- 
holders  in  the  United  States  and  Canada.  The  southern  and  south- 
western business  of  the  Company  in  1916  constituted  approxi- 
mately 20  per  cent,  of  the  total  exposure.  The  total  rate  is  there- 
fore devoid  of  much  meaning  although  the  figures  for  the  incidence 
by  color,  sex  and  age  do  show  interesting  interrelations  and  these 
are  given  in  the  following  table : 

TABLE  168. 
MORTALITY  FROM  MALARIA,  CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 

Death  Eates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

4.3 

2.1 

1.9 

17.8 

22.1 

1  to  4  

6.5 
3.2 
1.9 
1.9 
2.8 
3.4 
3.8 
6.5 
10.0 
16.0 
15.4 

3.7 
2.2 
1.1 
.9 
1.2 
1.4 
2.0 
3.3 
3.9 
8.4 
9.9 

3.7 
1.7 
1.1 
.7 
1.2 
1.1 
1.3 
2.6 
4.5 
7.0 
4.2 

42.9 

16.6 
5.4 
9.9 
13.8 
12.4 
11.2 
24.4 
41.4 
81.9 
123.5 

44.4 
17.3 
13.4 
12.9 
14.5 
14.7 
16.1 
29.0 
54.6 
89.3 
99.8 

5  to  9  

10  to  14  

15  to  19  

20  to  24  

25  to  34  

35  to  44  

45  to  54  

55  to  64  

65  to  74  
75  and  over.  . 

Comparisons  between  the  white  and  colored  malaria  death  rates 
should  be  made  with  special  caution.     Most  of  the  colored  policy- 

18 


258 


MORTALITY   STATISTICS   OF   INSURED   WAGE   EARNERS. 


holders  in  the  Company's  experience  are  located  in  the  South  and 
Southwest,  and  this  fact  alone  would  conduce  to  a  much  higher 
malaria  death  rate  than  was  recorded  among  white  persons,  the 
majority  of  whom  are  located  in  northern  areas  not  affected  to  any 
great  extent  by  malarial  infection.  The  comparative  malaria  death 
rates  presented  in  the  introductory  table  to  this  section  will  give 
some  idea,  however,  of  the  relative  color  incidence  at  least  of  deaths 
from  malaria. 

According  to  the  age  statistics,  malaria  mortality  was  nearly 
eight  and  one-half  times  as  frequent  among  colored  males  and 
nearly  12  times  as  frequent  among  colored  females  as  among  the 
corresponding  sex  groups  of  the  white  population.  Males  of  the 
white  experience  showed  a  malaria  death  rate  practically  eleven  per 
cent,  higher  than  did  females  of  the  same  race  group.  Colored 
males,  on  the  other  hand,  showed  a  malaria  mortality  practically 
twenty  per  cent,  more  favorable  than  the  rates  for  colored  females. 
It  is  not  possible  to  account  for  this  reversal  of  the  sex  ratio  of 
malaria  mortality  from  the  facts  at  hand. 

The  age  characteristics  of  the  malaria  mortality  curve  are  well 
defined.  The  highest  rates  are  found  at  the  two  extremes  of  life, 
the  minimum  being  reached  at  the  period  of  adolescence.  From 
age  20  onward  the  rates  increased  fairly  regularly  with  only  here 
and  there  an  exception.  A  high  mortality  figure  for  the  period  of 
early  childhood  is  to  be  noted. 

TABLE  169. 
MORTALITY  FROM  MALARIA,  CLASSIFIED  BY  SEX  AND  BY  AGE  PERIOD. 

Death  Sates  per  100,000  Persons  Exposed.     1910  to  1915. 
Experience  of  the  Expanding  Registration  Area  of  the  United  States. 


Age  Period. 

Males. 

Females. 

All  ages  —  one  and  over     

24 

2  4 

1  to  4     

4.4 

49 

5  to  9     

1.7 

1  6 

10  to  14   

1.0 

1  2 

15  to  19       

1.2 

1  3 

20  to  24           

1.5 

1  7 

25  to  34   

1.5 

1.6 

35  to  44   

1.8 

1.7 

45  to  54     

2.7 

2.3 

55  to  64       

4.5 

3.6 

65  to  74       

5.9 

6.0 

75  and  over  

13.1 

11.6 

MALARIA. 


259 


Because  of  the  sharp  differences  in  geographic  distribution  of 
the  two  groups  of  exposed  lives  it  is  not  deemed  desirable  to  make 
a  direct  comparison  between  the  death  rates  of  insured  wage  earners 
and  those  for  the  general  population  in  the  expanding  Registration 
Area  of  the  United  States.  It  may  be  of  interest,  however,  to 
observe  the  very  similar  conformation  of  the  curve  of  mortality  by 
age  and  sex  in  the  Registration  Area  during  the  period  1910  to 
1915.  This  is  offered  on  page  258. 

At  some  of  the  age  periods  the  death  rates  of  the  insured  expe- 
rience are  higher  and  at  others  they  are  lower  than  those  shown  for 
the  Registration  Area  considered  by  sex,  but  no  significance  may 
be  attached  to  these  ratios.  The  population  mortality  figures  for 
the  disease,  however,  are  valuable  in  that  they  confirm  the  relation 
previously  outlined  in  the  death  rates  by  age  period,  namely,  a  crest 
at  each  end  of  the  mortality  curve  and  a  minimum  point  between 
10  and  20  years  of  age. 

Trend  of  the  Malaria  Death  Rate — 1911  to  1916. 

The  malaria  death  rate  of  1911  was  the  highest  and  the  rate  of 
1916  was  the  lowest  in  the  Industrial  experience.  During  this 
period  the  rate  declined  without  exception,  the  figure  for  1916 
being  less  than  one-half  that  recorded  for  1911.  The  decline  was 
more  pronounced  for  white  than  for  colored  persons  and  greater 
for  females  than  for  males  in  each  color  group.  The  facts  are 
shown  below  for  each  of  the  single  calendar  years : 

TABLE  170. 
MORTALITY  FROM  MALARIA,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 

Death  Bates  per  100,000  Persons  Exposed.    Single  Years  in 
Period  1911  to  1916. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

1911  to  1916  

4.3 

2.1 

1.9 

17.8 

22.1 

1916  

2.9 
3.5 
3.7 
4.5 
5.4 
6.1 

1.4 
1.7 
1.7 
2.1 
3.1 
3.2 

1.3 

1.8 
1.6 
1.8 
2.4 
3.0 

14.4 
14.3 
16.2 
20.5 
20.9 
21.2 

15.1 
17.7 
21.0 
23.5 
26.6 
30.6 

1915  

1914  

1913  

1912  

1911  

260       MORTALITY  STATISTICS  OF  INSURED  WAGE  EARNERS. 

ANGINA  PECTORIS. 

Two  thousand  two  hundred  and  eighteen  (2,218)  deaths  from 
angina  pectoris  were  reported  in  this  experience  during  the  six 
year  period  1911  to  1916,  corresponding  to  a  death  rate  of  4.1  per 
100,000  exposed.  In  no  year  was  the  mortality  from  this  cause 
noticeably  high  as  compared  with  other  years.  The  maximum 
death  rate  was  observed  in  1913  (4.4)  and  the  minimum  in  1916 
(3.8). 

The  death  rates  for  the  expanding  Registration  Area  of  the 
United  States  showed  the  same  general  uniformity  but  were  con- 
siderably higher  than  those  for  the  Metropolitan  experience.  The 
maximum  rate  for  the  Registration  Area  during  the  sexennium  was 
7.7  per  100,000  population  in  1915  and  the  lowest  was  that  for 
1911  (7.1).  The  higher  mortality  in  the  Registration  Area  as 
compared  with  the  Metropolitan  experience  was  due  almost  alto- 
gether to  the  age  distribution  of  the  two  experiences.  About  40 
per  cent,  of  the  deaths  due  to  angina  pectoris  are  those  of  persons 
over  70  years  of  age  and  the  exposure  at  these  ages  is  very  much 
smaller  among  the  Industrial  policyholders  than  in  the  population 
of  the  Registration  Area. 

Color,  Sex  and  Age  Incidence. 

The  death  rates  for  Metropolitan  policyholders  were  identical  for 
white  and  colored  males  (4.6),  but  showed  a  rather  marked  excess 
for  colored  females  (5.8)  over  white  females  (3.5).  Among  white 
policyholders,  the  death  rate  for  males  was  higher  than  that  for 
females,  but  among  colored  policyholders  the  contrary  was  true. 
Among  white  decedents,  the  excess  of  mortality  of  males  over  fe- 
males was  very  marked  for  the  age  groups  in  which  the  greatest 
number  of  deaths  occurred,  namely,  45  to  54,  55  to  64  and  65  to 
74  years.  Among  colored  persons  the  rates  for  females  for  the  age 
periods  45  to  54  years  (15.7)  and  65  to  74  years  (38.8)  were  much 
higher  than  those  for  males  at  these  age  periods  (10.1  and  30.1) ; 
for  the  period  55  to  64  years,  however,  the  male  rate  (21.0)  slightly 
exceeded  the  female  rate  (19.8). 

The  following  table  presents  the  facts  by  color,  sex  and  age : 


ANGINA   PECTOBIS. 


261 


TABLE  171. 
MORTALITY  FROM  ANGINA  PECTORIS,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

4.1 

4.6 

3.5 

4.6 

5.8 

1  to  24   

.2 
1.2 
3.4 

8.3 
21.4 
49.4 
70.1 

.1 

1.2 
3.5 
12.0 

28.9 
68.8 
73.8 

.2 
.9 
2.2 
4.6 
16.8 
39.8 
73.7 

.5 
2.0 
7.6 
10.1 
21.0 
30.1 

.3 

2.8 
6.4 
15.7 
19.8 
38.8 
54.4 

25  to  34   .... 

35  to  44   

45  to  54   .... 

55  to  64   

65  to  74   

75  and  over.  . 

In  the  analysis  of  these  figures,  it  should  be  borne  in  mind  that 
the  number  of  deaths  involved  among  colored  policyholders  was 
only  352  and  that  this  number  is  quite  too  small  to  use  as  a  basis 
for  important  conclusions.  Another  point  should  be  remembered, 
namely,  that  the  term  "angina  pectoris"  is  used  loosely  in  this 
country.  It  is  still  a  favorite  expression,  especially  with  coroners, 
in  cases  of  sudden  death. 

ULCER  OF  THE  STOMACH. 

Ulcer  of  the  stomach  caused  2,159  deaths  among  Metropolitan 
Industrial  policyholders  during  the  six  year  period  1911  to  1916, 
corresponding  to  a  death  rate  of  4.0  per  100,000  exposed.  Ex- 
amination of  the  rates  for  the  different  years  shows  that  there  were 
no  fluctuations  of  importance,  the  rate  for  1915  (3.8)  showing  the 
greatest  deviation  from  the  average  for  the  period.  The  death  rate 
for  ulcer  of  the  stomach  in  the  Registration  Area  showed  a  slight 
upward  trend;  in  fact  this  has  been  continuous  during  the  period, 
the  maximum  (4.6)  being  that  for  the  year  1916. 

Color,  Sex  and  Age  Incidence. 

The  crude  death  rates  for  the  Metropolitan  Industrial  policy- 
holders  indicate  a  higher  incidence  for  colored  persons  than  for 
white  persons,  and  a  preponderance  of  mortality  of  males  among 


262 


MORTALITY    STATISTICS   OF   INSURED   WAGE  EARNERS. 


the  white,  but  of  females  among  the  colored.  Among  the  males,  the 
highest  rates  were  found  at  the  age  period  75  and  over,  21.3  per 
100,000  for  the  white  and  41.2  per  100,000  for  the  colored.  There 
was  a  continuous  increase  throughout  the  lower  age  periods  until 
the  maximum  was  reached  at  the  age  period  75  years  and  over. 
Females  had  the  highest  rates  at  the  age  period  65  to  74  (17.9  and 
28.2  per  100,000  white  and  colored  policyholders  respectively). 
Beginning  with  the  earliest  period,  they  also  showed  a  continuous 
increase  throughout  the  lower  age  groups. 

The  following  table  shows  the  color,  sex  and  age  incidence  of 
ulcer  of  the  stomach  among  Metropolitan  Industrial  policyholders : 

TABLE  172. 

MORTALITY  FROM  ULCER  OF  THE  STOMACH,  CLASSIFIED  BY  COLOR,  SEX 
AND  BY  AGE  PERIOD. 

Death  Kates  per  100,000  Persons  Exposed.    1911  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males.              Females. 

Males. 

Female*. 

All  ages  —  one  and  over 
1  to  19  .  . 

4.0 

4.3 

3.1 

6.2 

6.4 

.4 
2.0 
3.9 
7.6 
9.7 
12.9 
19.7 
18.7 

.3 
1.8 
4.6 
10.3 
15.3 
17.4 
19.1 
21.3 

.4 
1.8 
2.8 
5.0 
6.0 
9.3 
17.9 
15.9 

.4 
2.3 

5.5 
11.8 

11.1 

16.2 
35.1 
41.2 

1.1 
4.0 
6.3 
9.1 
10.7 
15.0 
28.2 
18.1 

20  to  24  

25  to  34  

35  to  44  

45  to  54   

55  to  64   

65  to  74  

75  and  over  

ACUTE  POLIOMYELITIS. 

With  the  exception  of  the  single  year  1916,  acute  poliomyelitis 
has  caused  only  between  100  and  150  deaths  per  annum  in  the  en- 
tire mortality  experience  of  insured  wage  earners  under  review. 
The  death  rate  varied  from  1.2  to  1.8  per  100,000  persons  exposed 
between  1911  and  1915.  In  1916,  however,  an  epidemic  of  the 
disease  occurred  and  the  rate  rose  to  12.2  per  100,000.  The  cases 
in  that  year  were,  for  the  most  part,  confined  to  the  Middle  Atlantic 
and  to  a  few  of  the  New  England  States.  The  City  of  New  York 
showed  by  far  the  largest  number  of  cases  recorded.  Out  of  the 
total  of  1,245  cases  registered  in  1916,  456  or  36.6  per  cent,  were 


ACUTE  POLIOMYELITIS. 


263 


reported  from  that  city.     There  was  also  a  noteworthy  representa- 
tion of  deaths  from  the  cities  of  Newark  and  Philadelphia. 

Poliomyelitis  has  a  very  marked  color,  sex  and  age  incidence. 
In  this  respect,  it  is  very  similar  to  the  other  acute  infectious  dis- 
eases of  childhood  already  considered.  This  is  made  evident  in  the 
following  table,  which  displays  the  color,  sex  and  age  incidence  of 
this  disease  for  1916  alone: 

TABLE  173. 

MORTALITY  FROM  ACUTE  POLIOMYELITIS,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Bates  per  100,000  Persons  Exposed.     Year  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persons. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

12.2 

16.9 

10.2 

6.2 

3.5 

1  to  4  

86.4 
26.9 
4.8 
2.4 
1.2 
.4 

99.7 
31.8 
5.7 
3.2 
1.0 
.9 

75.3 
23.5 
4.9 
1.6 
1.2 
.3 

79.4 
19.1 

1.9 
3.6 

53.0 
15.1 

1.7 

5  to  9  

10  to  14  

15  to  19  

20  to  24.  .... 

25  and  over.  . 

White  males  and  white  females  suffer  much  more  acutely  from 
poliomyelitis  than  do  the  same  sex  groups  among  colored  people. 
It  should  be  recalled,  though,  that  in  this  mortality  experience 
colored  and  white  persons  were  very  unequally  exposed  to  the  dis- 
ease. Males  show  higher  mortality  rates  than  do  females  at  every 
age  period  with  the  exception  of  the  age  period  20  to  24  years.  The 
disease  takes  its  highest  toll  in  the  earliest  years  of  childhood.  In 
fact,  the  rate  for  white  males  under  five,  99.7  per  100,000,  was 
higher  than  the  death  rate  for  measles  (84.1  per  100,000)  and  for 
scarlet  fever  (53.5  per  100,000)  in  the  corresponding  age  period  of 
life.  The  same  fact  was  observed  for  the  age  period  five  to  nine. 
The  rates  decrease  rapidly  beginning  with  age  ten  years,  and  the 
deaths  are  very  few  after  age  25.  Only  100  deaths  after  age  25 
occurred  out  of  the  total  of  1,889  deaths  in  the  six  year  period. 


CHAPTER  XVII. 
MISCELLANEOUS  DISEASES  AND  CONDITIONS. 

In  addition  to  the  major  diseases  and  conditions  discussed  in  the 
foregoing  text  there  are  a  number  which  have  played  a  not  incon- 
siderable part  in  this  mortality  experience.  Some  of  these  justify 
brief  discussion  because  of  their  importance  as  public  health  prob- 
lems, irrespective  of  the  relatively  small  number  of  deaths  due  to 
them;  others  claim  attention  because  they  illustrate  recent  tenden- 
cies in  the  technique  of  mortality  statistics.  The  figures  represent- 
ing the  number  of  deaths  from  these  minor  conditions  should  be 
accepted  in  most  cases  with  some  reservation.  In  practically  all 
instances  there  has  been  an  apparent  decline  in  the  death  rate  for 
these  causes  of  death  during  the  six  year  period.  This,  we  believe, 
is  due,  in  large  part,  to  improved  certification  of  the  causes  of  death 
by  physicians.  The  increasing  interest  of  physicians  in  preventive 
medicine,  the  circulation,  by  various  vital  statistics  offices,  of  educa- 
tional literature  on  the  certification  of  causes  of  death,  and  the  many 
letters  written  to  physicians  asking  them  for  more  definite  state- 
ments of  causes  of  death,  have  resulted  in  reducing  by  many  thou- 
sands the  registration  of  deaths  under  these  titles  and  correspond- 
ingly increasing  the  numbers  assigned  to  the  more  approved  and 
reliable  headings  of  the  International  List.  These  diseases  and 
conditions  of  miscellaneous  order  will  be  considered  according  to 
their  International  List  position. 

Dysentery. 

Under  dysentery  were  classified  2,029  deaths  during  the  expe- 
rience period,  corresponding  to  a  death  rate  of  3.8  per  100,000 
exposed.  There  has  been  a  practically  continuous  decline  in  the 
death  rate  during  the  sexennium.  The  maximum  rate  is  that  for  the 
year  1911  (4.8).  The  minimum  rate  was  recorded  in  1916  (3.1). 
The  term  "dysentery"  is  used  by  physicians  very  loosely  in  this 
country.  True  amebic  dysentery,  caused  by  the  ameba  dysen- 
teriae,  is  comparatively  rare  in  North  America  with  the  exception 

264 


MISCELLANEOUS    DISEASES    AND   CONDITIONS.  265 

of  the  southern  states.  The  type  known  as  bacillary  dysentery, 
which  occurs  both  sporadically  and  in  epidemics,  is  also  infrequent 
because  of  steadily  improving  sanitary  conditions.  It  has  been 
estimated,  and,  in  fact,  fairly  well  demonstrated  by  registration 
offices,  that  a  large  proportion  of  the  "dysentery"  (so  reported)  in 
the  United  States  is  really  enteritis  or  gastroenteritis.  This  is 
true  especially  in  cases  where  it  is  reported  for  infants  under  two 
years  of  age.  Examination  of  the  Census  Bureau  reports  on  mor- 
tality statistics  shows  that  approximately  one  third  of  the  mortality 
reported  for  dysentery  is  that  of  children  under  two  years  of  age. 
Very  little  of  this,  as  a  matter  of  fact,  is  correctly  assignable  to 
this  title.  The  deaths  which  have  been  "charged  away"  from 
dysentery  in  the  insurance  experience  have  gone  to  swell  the  totals, 
chiefly,  of  diarrhea  and  enteritis  and  abdominal  tuberculosis. 

Erysipelas. 

Twelve  hundred  and  eighty-nine  erysipelas  (1,289)  deaths  were 
registered  during  the  six  year  period  1911  to  1916.  The  death 
rate  was  2.4  per  100,000  exposed.  There  has  been  no  marked 
change  during  the  period  in  the  death  rate  for  this  condition.  The 
death  rates  for  white  policyholders  are  considerably  in  excess  of 
those  for  the  colored,  and  the  mortality  among  males  for  each  race 
exceeds  that  among  females.  In  the  general  population  experience 
the  death  rates  are  higher  than  those  for  the  Company's  Industrial 
policyholders.  This  is  due  chiefly  to  the  fact  that  approximately 
one  third  of  the  mortality  caused  by  erysipelas  is  among  infants 
under  one  year  of  age,  a  class  which  does  not  form  a  part  of  the 
Metropolitan  experience. 

Under  erysipelas  are  classified  all  deaths  so  reported,  with  no 
information  as  to  type  or  primary  cause.  These  include  cases  of 
slight  traumatism  complicated  by  the  disease,  but  do  not  include 
those  deaths  in  which  erysipelas  supervenes  nor  violence  cases  where 
the  traumatism,  in  itself,  would  have  caused  death. 

Purulent  Infection  and  Septicemia. 

Under  this  heading  were  classified  1,083  deaths,  corresponding 
to  a  death  rate  of  2.0  per  100,000  exposed.  The  general  trend  of 
mortality  throughout  the  six  year  period  has  been  downward.  Sev- 
eral hundreds  of  deaths  which  would  have  been  classified  under  this 


266          MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

heading  on  the  basis  of  the  original  reports  received  from  physi- 
cians, have  been  transferred  to  other  titles  on  the  basis  of  more 
definite  data  supplied  by  these  physicians.  As  an  illustration  of 
the  loose  manner  in  which  the  term  "septicemia"  is  used  by 
American  physicians,  we  may  cite  the  result  shown  by  295  replies 
from  physicians1  who  reported  it  as  a  cause  of  death  of  policy- 
holders  in  this  investigation  during  the  six  years  1911  to  1916.  In 
207,  or  70.2  per  cent,  of  these  cases,  the  deaths,  on  the  basis  of  the 
corrective  data  furnished  by  the  physicians,  were  charged  to  titles 
other  than  purulent  infection  and  septicemia.  Of  the  207  replies 
that  were  received  76  or  25.8  per  cent,  were  assigned  to  puerperal 
septicemia  alone.  The  remainder  were  scattered  among  various 
diseases  and  forms  of  violence.  The  published  death  rate  in  the 
expanding  Kegistration  Area  of  the  United  States  has  been  showing 
a  decreasing  trend  for  many  years  which,  also,  is  due  to  the  fact 
that  physicians  are  reporting  under  the  primary  diseases  cases 
where  blood  poisoning  was  a  complication  of  the  primary  causative 
condition. 

Gonococcus  Infection. 

The  number  of  deaths  charged  to  this  disease  (200)  during  the 
six  years  covered  by  this  report  does  not  indicate  that  this  is  a 
factor  of  much  importance  in  this  mortality  experience.  The 
death  rate  for  the  period  was  but  .4  per  100,000  exposed  on  the 
basis  of  the  reports  of  gonococcus  infection  which  have  been  re- 
turned. Low  as  this  figure  is,  it  is,  nevertheless,  a  matter  of  in- 
terest that  when  the  rate  for  the  last  year  of  the  sexennium  (.5)  is 
compared  with  that  for  the  first  year  (.2)  it  is  seen  that  there  has 
been  an  apparent  increase  of  150  per  cent.  As  a  matter  of  fact, 
however,  this  rise  is  only  apparent  and  is  due,  in  large  part,  to  the 
constantly  increasing  care  which  physicians  are  exercising  in  re- 
porting primary  causative  factors  on  forms  provided  for  statements 
of  causes  of  death.  The  reports  for  the  general  population  show 
an  even  greater  apparent  increase  in  the  death  rate  for  gonococcus 
infection.  For  the  year  1916  the  general  population  death  rate 
was  .8  per  100,000  population,  which  is  double  the  rate  for  1911 
(.4)  and  eight  times  the  annual  average  rate  for  the  period  1901  to 
1905  (.1).  It  is  evident  that  published  figures  for  this  disease 

i  See  Appendix  C. 


MISCELLANEOUS   DISEASES    AND    CONDITIONS.  267 

can  not  be  taken  as  a  reliable  index  of  its  incidence  as  a  cause  of 
death. 

Anemia,  Chlorosis. 

One  thousand  seven  hundred  and  seventy-two  (1,772)  deaths 
were  charged  to  these  diseases  during  the  sexennium  1911  to  1916. 
The  great  majority  were  reported  under  one  of  the  following  ex- 
pressions: anemia  (without  qualification),  Band's  disease,  chloro- 
sis, pernicious  anemia,  and  splenic  anemia.  The  International 
List  of  causes  of  death  does  not  provide  for  the  separate  tabulation 
of  these  several  types.  Indeed,  the  title  itself  is  unsatisfactory ;  the 
term  "anemia"  is  very  vague  and  is  used  very  loosely  indeed;  so 
much  so,  that  it  is  probable  that  many  fatal  cases  so  diagnosed 
would  not  be  reported  under  this  title  heading  if  blood  examina- 
tions had  been  made.  In  many  cases  the  deaths  here  tabulated 
result  either  from  acute  or  chronic  secondary  anemias,  and  if  all 
of  the  data  for  correct  classification  had  been  at  hand,  they  would, 
doubtless,  have  been  assigned  to  many  other  causes,  prominent 
among  which  are  malarial  fever,  rheumatic  fever,  syphilis,  malig- 
nant growths,  the  autogenous  poisonings  resulting  from  various 
chronic  diseases,  and  indeed  in  some  cases,  to  traumatic  agencies. 

It  will,  therefore,  be  understood  that  the  title  "anemia,  chloro- 
sis" relates  only  in  part  to  proved  fatal  cases  of  the  two  forms  of 
primary  or  essential  anemia  known  as  chlorosis  and  pernicious 
anemia. 

It  will  be  noted  that  in  the  Metropolitan  Industrial  experience 
there  has  been  little  change  in  the  death  rate  during  the  six  year 
period  1911  to  1916.  A  slight  upward  trend  is  shown.  This  cor- 
responds with  the  general  population  experience  as  shown  by  the 
Census  Office  reports  on  mortality  statistics. 

"  Other  Chronic  Poisonings." 

Only  164  deaths  were  charged  to  this  title  (No.  59  of  the  Inter- 
national List  of  Causes  of  Death)  during  the  period  1911  to  1916. 
These  deaths  were  cases  reported  as  due  chiefly  to  chronic  morphin- 
ism, opium  poisoning  and  cocainism.  It  should  be  understood  that 
the  chronic  occupational  poisonings  are  not  classified  here ;  nor  are 
any  of  the  acute  poisonings,  whether  occupational  or  not.  The 
chief  interest  in  the  figures  attaches  to  the  fact  that  during  the  first 
four  years  of  the  sexennium  there  was  little  change  in  the  death 


268          MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 

rate.  In  1915,  however,  there  was  a  considerable  increase,  but  in 
1916  the  death  rate  dropped  very  materially.  This  corresponds 
with  the  general  population  experience,  and  it  may  be  presumed 
that  the  very  pronounced  decrease  in  the  death  rate  in  1916  was 
due  to  the  enforcement  of  legislation  covering  the  sale  of  habit- 
forming  drugs. 

Encephalitis. 

Under  this  vague  and  indeterminate  heading,  519  deaths  were 
classified.  This  corresponds  to  a  death  rate  of  1.0  per  100,000 
exposed.  There  has  been  a  steady  downward  trend  in  the  mor- 
tality charged  to  this  disease  throughout  the  period  and  the  rate 
for  the  final  year,  1916  (.8),  represents  an  apparent  decline  of 
33£  per  cent,  from  that  for  the  first  year,  1911  (1.2).  This  appar- 
ent decline  should  be  construed  as  having  very  little  significance 
other  than  to  serve  as  an  evidence  of  the  increasing  accuracy  with 
which  causes  of  death  are  being  reported  year  after  year.  Without 
question  many  deaths  are  being  added  to  the  totals  classified  as  due 
to  tuberculous  meningitis  and  to  the  various  forms  of  violence  on 
account  of  the  growing  tendency  to  specify  the  primary  factor  in 
cases  of  terminal  encephalitis.  This  downward  trend  in  the  appar- 
ent death  rate  is  also  seen  in  the  experience  of  the  expanding  Reg- 
istration Area. 

Meningitis. 

Four  thousand  one  hundred  and  seventy-one  (4,171)  deaths  were 
classified  under  "meningitis"  during  the  period  1911  to  1916. 
This  title,  unfortunately,  is  a  composite  one  and  includes  not  only 
the  condition  known  as  "simple  meningitis,"  which  is  usually  a 
terminal  condition  in  other  primary  diseases,  but  also  the  epidemic 
cerebrospinal  type  which  is  an  infectious  disease.  Of  the  4,171 
deaths,  3,348  were  returned  as  due  to  the  former  group  of  condi- 
tions such  as  "simple  meningitis,"  " meningitis,'*  without  further 
qualification,  "cerebral  meningitis,"  "spinal  meningitis,"  and  823 
deaths  were  reported  as  due  to  cerebrospinal  fever. 

The  statistical  tabulation  of  deaths  returned  under  the  first  group 
is  hardly  worth  while,  because  such  reports  are  but  partial  reports, 
and  as  such,  figures  relating  to  them  are  bound  to  be  misleading. 
Experience  and  tests  have  shown  that  over  three-fourths  of  the 
deaths  returned  in  this  manner  were  really  primarily  due  to  other 
conditions,  chief  among  which  are  tuberculous  meningitis,  syphilis, 


MISCELLANEOUS   DISEASES   AND    CONDITIONS. 


269 


cerebrospinal  fever  and  diseases  of  the  ears.  The  3,348  deaths  just 
referred  to  represent  cases  in  which  it  was  not  possible  to  secure 
information  either  as  to  the  type  of  "meningitis"  or  the  name  of 
the  disease  or  form  of  violence  of  which  it  was  a  sequela. 

Cerebrospinal  Fever. — The  chief  interest  in  the  study  of  menin- 
gitis statistics  is  centered  on  the  823  deaths  relating  to  cerebro- 
spinal fever,  or  to  epidemic  cerebrospinal  meningitis  as  it  is  often 
called.  This  is  an  acute  infectious  disease  caused  by  an  organism 
known  as  the  dlplococcus  vntracellularis  meningitidis.  While  it 
is  marked  by  fever  and  by  inflammation  of  the  cerebral  and  the 
spinal  meninges,  its  place  in  a  statistical  classification  should  be 
among  the  specific  infectious  diseases  rather  than  among  those  of 
the  nervous  system,  where  it  is  at  present  placed. 

In  the  first  year  of  the  sexennium  to  which  this  report  relates, 
no  effort  was  made  to  segregate  the  deaths  from  this  disease.  The 
two  tables  which  follow  relate,  therefore,  to  a  quinquennial  period, 
1912  to  1916.  The  first  of  these  tables,  which  is  given  immediately 
below,  shows  the  sex,  color  and  age  distribution  of  the  mortality 
among  the  insured  for  this  period. 

TABLE  174. 

MORTALITY  FROM  CEREBROSPINAL  FEVER,  CLASSIFIED  BY  COLOR,  SEX  AND  BY 

AGE  PERIOD. 

Death  Eates  per  100,000  Persons  Exposed.    1912  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Age  Period. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Males. 

Females. 

All  ages  —  one  and 
over  

1.8 

2.1 

1.2 

3.8 

2.4 

1  to  4     

7.2 
2.6 
1.8 
1.7 
1.1 
.8 
.7 
.8 
.3 
.4 

8.0 
2.4 
1.6 
2.4 
1.0 
.8 
.7 
.9 
.4 
.3 

6.3 
2.1 
1.3 
.7 
.8 
.5 
.4 
.2 
.1 
.6 

9.2 

7.3 
4.9 
5.0 
3.5 
2.7 
1.6 
3.4 
.7 

6.9 
4.9 
4.8 
1.7 
1.9 
1.3 
1.5 
2.1 
1.6 

5  to  9     .... 

10  to  14.  .  .>. 
15  to  19   

20  to  24   .... 

25  to  34   

35  to  44   . 

45  to  54  

55  to  64  

65  to  74  

75  and  over.  . 

There  were  823  deaths  either  originally  reported  or  finally  iden- 
tified in  our  experience  during  the  quinquennium  1912  to  1916  as 


270 


MORTALITY    STATISTICS   OF   INSURED   WAGE    EARNERS. 


due  to  cerebrospinal  fever.  Over  one-third  of  these  were  deaths  of 
children  1  to  4  years  of  age ;  over  one-half  were  under  10  and  about 
two-thirds  under  15.  The  mortality  for  males  in  both  the  colored 
and  white  experience  was  very  considerably  in  excess  of  that  for 
females  and  for  each  sex  the  death  rate  for  the  colored  experience 
was  heavily  in  excess  of  that  for  the  white. 

The  following  table  shows  the  trend  of  the  death  rate  for  cerebro- 
spinal fever  during  the  quinquennial  period  1912  to  1916.  It  will 
be  noted  that  the  decline  was  a  continuous  one  for  the  first  four 
years  of  the  quinquennium,  that  is,  from  a  maximum  of  3.0  per 
100,000  exposed  in  1912  to  a  minimum  of  1.3  in  1915.  This  was 
followed  by  a  slight  increase  to  1.5  in  1916.  The  experience  for 
the  insured  corresponds  fairly  well  with  that  for  the  general  popu- 
lation except  that  for  1916  the  latter,  with  a  rate  of  2.1  per  100,000 
population,  shows  more  of  an  excess  over  the  1915  rate  than  is  in 
evidence  for  the  corresponding  year  in  the  Metropolitan  experience. 

TABLE  175. 

MORTALITY  FROM  CEREBROSPINAL  FEVER,  CLASSIFIED  BY  COLOR  AND  BY  SEX. 
Death  Bates  per  100,000  Persons  Exposed.     Single  Years 

in  Period  1912  to  1916. 
Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Department. 


Year. 

Persona. 

White. 

Colored. 

Males. 

Females. 

Malta. 

Females. 

1912  to  1916  

1.8 

2.1 

1.2 

3.8 

2.4 

1916  

1.5 
1.3 

1.5 
1.7 
3.0 

1.9 
1.8 
1.8 
1.8 
3.1 

1.2 
14 

i.l 
1.4 
1.5 

2.0 
.9 
2.7 
3.4 
10.4 

1.4 
.8 
1.1 
2.3 
6.6 

1915  

1914  

1913     

1912  

Locomotor  Ataxia.  * 

The  most  important  causative  factor  in  locomotor  ataxia  is  syph- 
ilis, and,  in  fact,  some  of  the  best  authorities  now  say  that  the 
disease  never  originates  without  syphilis.  On  this  account  deaths 
certified  as  due  to  locomotor  ataxia  should  be  considered  in 
relation  to  syphilis,  and  in  Appendix  C  there  will  be  found 
quotations  of  the  number  of  deaths  charged  to  syphilitic  in- 
fection in  which  it  had  been  definitely  certified  by  physicians 
that  the  syphilitic  origin  of  locomotor  ataxia  had  been  attested  by 

*See  also  syphilis,  page  237. 


MISCELLANEOUS   DISEASES    AND    CONDITIONS.  271 

Wassermann  reactions.  On  account  of  the  growing  tendency  of 
physicians  to  certify  primary  causes,  and  on  account  of  the  practise 
among  some  statistical  offices  of  requesting  physicians  to  certify 
definitely  to  the  luetic  origin  of  deaths  ascribed  to  locomotor  ataxia, 
the  death  rate  for  locomotor  ataxia  is  showing  an  apparent  decline. 
This  decline  has  been  continuous  in  the  present  experience  for  in- 
sured wage  earners  throughout  the  last  four  years  of  the  six  year 
period  covered  by  this  report.  This  is  not  in  agreement  with  the 
death  rates  shown  for  the  expanding  Registration  Area  in  which 
for  four  of  the  six  years  there  was  no  change.  There  was  a  decline, 
however,  from  2.6,  the  1915  rate  in  the  general  population,  to  2.4 
per  100,000  population  in  1916.  The  Registration  Area  death 
rates  are  considerably  higher  than  those  for  the  insured.  This  is 
accounted  for,  in  part,  by  the  age  distribution  of  the  two  popula- 
tions. Well  over  one-third  of  the  deaths  from  the  disease  occurs  in 
the  higher  age  periods  where  the  policyholders  do  not  comprise  a 
very  high  proportion  of  the  total  number  insured. 

Softening  of  the  Brain. 

Under  this  heading,  488  deaths  of  Industrial  policyholders  were 
classified  during  the  six  year  period  1911  to  1916.  The  death  rate 
for  the  period  was  .9  per  100,000  exposed.  Examination  of  the 
apparent  trend  of  the  death  rate  shows  a  practically  continuous 
downward  trend  during  the  six  years  and  the  rate  for  1916  (.7) 
is  58.3  per  cent,  of  that  for  1911.  Softening  of  the  brain  is  an 
extremely  unsatisfactory  statement  of  cause  of  death  in  that  it  is 
a  secondary  condition  rather  than  a  primary  cause.  This  explains 
the  apparent  downward  trend  in  the  mortality  which  the  figures 
for  the  years  of  the  sexennium  show.  The  fact  is  that  in  the  later 
years  registration  offices  have  been  querying  this  return,  with  the 
result  that  many  deaths  originally  certified  as  due  to  softening  of 
the  brain  have  been  registered,  instead,  under  arteriosclerosis,  em- 
bolism, thrombosis,  and  other  diseases,  as  a  result  of  more  definite 
information  so  secured.  The  apparent  decrease  shown  for  the  in- 
sured group  corresponds  to  that  shown  for  the  general  population. 

General  Paralysis  of  the  Insane. 

Two  thousand  two  hundred  and  twenty-four  (2,224)  deaths  of 
Metropolitan  Industrial  policyholders  were  classified  as  due  to 


272          MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 

this  disease  during  the  six  year  period,  1911  to  1916.  The  death 
rate  was  4.1  per  100,000  exposed.  In  view  of  the  fact  that  the 
antecedent  cause  of  general  paralysis  of  the  insane  is  now  believed 
by  the  best  authorities  to  be  syphilis,  a  separate  statistical  treat- 
ment of  the  mortality  from  general  paralysis  is  of  little  value.  It 
has  been  decided,  therefore,  to  treat  it  in  connection  with  the  study 
of  syphilis,  page  237.  When  this  condition  is  reported  jointly  with 
syphilis,  the  death  is  classified  as  one  primarily  due  to  the  latter, 
but  very  frequently  indeed,  physicians  simply  report  "general 
paralysis  of  the  insane,"  "dementia  paralytica,"  "paresis,"  or 
"general  paralysis"  without  stating  specifically  that  these  condi- 
tions occurred  as  the  result  of  initial  syphilitic  infection.  Since 
the  International  List  of  Causes  of  Death  provides  a  separate  title 
for  general  paralysis  of  the  insane  we  have  (in  keeping  with  stand- 
ard practise)  classified  under  general  paralysis  all  deaths  in  which 
syphilitic  origin  was  not  definitely  stated  by  physicians,  except  that 
in  very  many  cases  letters  of  inquiry  were  sent  to  physicians  asking 
them  whether  they  had  knowledge  of  the  existence  of  syphilis  as  a 
predisposing  cause  and,  if  so,  whether  its  presence  was  shown  by 
history  or  by  tests.  The  replies  in  a  great  many  instances  gave  us 
information  on  the  strength  of  which  many  deaths  originally  cer- 
tified as  due  to  general  paralysis  of  the  insane  were  ultimately 
classified  under  the  heading  of  syphilis. 

Analysis  of  the  apparent  trend  of  the  death  rate  among  the 
Company's  policyholders  shows  a  very  pronounced  decrease  for 
general  paralysis  of  the  insane.  The  death  rate  for  1916  (2.7  per 
100,000  exposed)  is  less  than  half  that  for  1911  (5.7)  and  with 
one  exception  there  was  a  continuously  declining  death  rate 
throughout  the  period  1911  to  1916.  The  declining  rate  shown  for 
the  Metropolitan  experience  is  in  marked  contrast  to  the  increasing 
mortality  shown  by  the  reports  of  the  Census  Bureau  for  the  ex- 
panding Eegistration  Area  of  the  United  States  throughout  the 
same  period.  It  was  not  the  custom  in  the  Census  Bureau  during 
the  period  1911  to  1916  to  query  reports  of  general  paralysis  for 
specific  statements  of  the  existence  of  syphilis. 

The  color  and  sex  incidence  of  the  death  rates  for  general  paral- 
ysis of  the  insane  is  about  the  same  as  for  syphilis.  The  death 
rates  for  males  exceed  those  for  females  in  the  colored  as  well  as  in 
the  white  experience,  and  the  rate  for  colored  persons  is  very  much 
higher  for  each  sex  than  that  for  the  whites. 


MISCELLANEOUS   DISEASES   AND    CONDITIONS.  273 

Convulsions. 

Five  hundred  and  fifty-nine  (559)  deaths  were  charged  to  "con- 
vulsions "  in  this  experience.  The  International  List  of  Causes  of 
Death  devotes  two  title  headings  to  this  subject,  one  of  which  is 
confined  to  deaths  of  children  under  5  years  of  age  and  the  other 
to  persons  5  years  of  age  and  over.  The  461  deaths  of  children 
under  5  years  classified  under  this  cause  are  assigned  thereto  only 
in  cases  where  it  was  impossible  to  secure  more  definite  informa- 
tion which  would  justify  the  inclusion  of  such  deaths  under  more 
definite  and  satisfactory  statistical  headings.  Convulsions  in 
young  children  represent  a  symptom-complex  of  some  other  condi- 
tion— in  the  majority  of  cases  such  diseases  as  diarrheal  complaints, 
the  pneumonias,  and  the  several  forms  of  meningitis.  Only  98 
deaths  of  persons  5  years  and  over  were  charged  to  convulsions 
during  the  six  year  period.  These  also  represent  cases  which  were 
assigned  to  this  title  only  when  it  was  not  possible  to  obtain  defi- 
nite data  which  would  justify  their  classification  elsewhere.  When 
such  information  is  obtained,  these  deaths  are  usually  transferred, 
in  cases  of  women  of  childbearing  age,  to  puerperal  causes,  and  in 
adult  males  to  the  various  nervous  diseases  or  to  some  form  of 
traumatism. 

The  death  rate  for  convulsions  is  declining,  which  is  a  manifesta- 
tion of  improvement  in  statements  of  cause  of  death  rather  than  an 
indication  of  changed  condition  as  to  the  incidence  of  fatal  cases 
of  "  convulsions/' 

" Other  Diseases  of  the  Nervous  System" 

Under  this  heading  of  the  International  List  of  Causes  of  Death 
are  classified  a  very  considerable  number  of  nervous  diseases  which 
are  not  covered  statistically  by  any  other  title  relating  to  the  vari- 
ous diseases  of  the  nervous  system  and  the  organs  of  special  sense. 
The  title,  therefore,  is  a  residual  one  and  many  of  the  diseases 
listed  under  it  are  so  dissimilar  to  others  so  listed,  that  the  only 
relationship  lies  in  the  fact  that  they  all  affect  the  nervous  system. 
Under  this  heading  the  following,  chiefly,  were  reported  as  causes 
of  death:  acute  hydrocephalus,  anemia  of  brain,  cerebral  tumor, 
cretinism,  disease  of  brain  (nature  not  specified  and  unobtainable 
on  inquiry),  idiocy,  imbecility,  Jacksonian  epilepsy,  nervous  ex- 
haustion, nervous  prostration,  neurasthenia,  sclerosis  of  brain, 
19 


274          MORTALITY   STATISTICS  OF   INSURED   WAGE   EABNERS. 

tetany  and  a  few  others.  Many  of  the  diseases  listed  under  this 
title  are  really  of  syphilitic,  or  more  or  less  remote  traumatic,  origin. 
These  deaths  would  have  been  so  classified  if  accurately  reported. 
The  death  rate  from  this  group  of  causes  in  the  present  experience 
shows  a  slight  downward  trend.  This  is  due  to  increasingly  specific 
statements  of  cause  of  death  resulting  from  the  widespread  cam- 
paign carried  on  by  practically  all  registration  offices  with  a  view 
to  securing  accurate  reports  from  physicians.  The  tendency  in  the 
expanding  Registration  Area  is  also  a  downward  one,  which  is 
attributable,  doubtless,  to  the  same  cause. 

The  number  of  deaths  recorded  under  this  residual  title  during 
the  period  1911  to  1916  was  1,349,  corresponding  to  a  death  rate  of 
2.5  per  100,000  exposed. 

Diseases  of  the  Ears. 

In  the  great  majority  of  the  fatal  cases  of  ear  disease  otitis  media 
is  the  primary  factor.  There  were  962  deaths  charged  to  ear  dis- 
eases in  the  Metropolitan  Industrial  experience  during  the  period 
1911  to  1916.  The  death  rate  was  1.8  per  100,000  exposed.  The 
prevailing  rate  throughout  the  years  of  the  sexennium  has  changed 
very  little  from  year  to  year.  This  corresponds  with  the  expe- 
rience in  the  expanding  Registration  Area  of  the  United  States, 
although  in  the  latter  experience  group  the  rate  in  recent  years  has 
been  much  higher  than  in  the  years  covering  the  first  quinquennium 
of  the  present  century.  There  has  not  been  an  actual  increase  in 
the  fatal  cases  of  ear  disease,  probably,  to  the  extent  indicated  by 
these  rates.  On  the  other  hand,  hundreds  of  physicians  who,  in 
earlier  years  would  have  certified  fatal  cases  of  otitis  media  as  due 
to  the  terminal  condition,  meningitis,  have  been  returning  such 
cases  in  more  recent  years,  under  the  stimulus  of  educational  propa- 
ganda, as  "otitis  media." 

Pericarditis. 

Under  this  heading  the  deaths  of  624  Metropolitan  Industrial 
policyholders  were  recorded  during  the  period  1911  to  1916.  The 
corresponding  death  rate  was  1.2  per  100,000  exposed.  The  trend 
of  the  death  rate  is  downward.  In  1911  the  rate  was  1.4,  in  1912 
and  1913  it  was  1.3  and  for  each  of  the  three  remaining  years  of 
the  sexennium  it  was  1.0  per  100,000.  The  apparent  downward 


MISCELLANEOUS   DISEASES   AND   CONDITIONS.  275 

trend  of  the  death  rate  in  the  Metropolitan  experience  corresponds 
fairly  well  to  that  in  the  Kegistration  Area.  Probably  the  decline  in 
each  experience  is  more  apparent  than  real.  Secondary  pericarditis 
is,  more  and  more,  being  recorded  under  the  primary  infection.  The 
disease  is  usually  the  result  of  pyogenic  infection  or  it  arises  by 
extension  of  inflammation  from  contiguous  organs.  As  a  primary 
condition  it  is  extremely  rare.  It  is  caused,  in  addition  to  the 
lesions  noted  above,  by  rheumatism,  traumatism,  and  indeed  in 
some  cases,  by  tuberculosis.  The  more  frequent  mention  of  pri- 
mary rheumatic  fever  and  other  causative  factors  on  forms  pro- 
vided for  reporting  causes  of  death  is  perhaps  the  chief  factor  in 
the  apparent  decline  of  the  pericarditis  death  rate. 

Under  this  heading  are  also  classified  certain  other  diseases  of 
the  pericardium,  namely,  hydropericardium,  hemopericardium  and 
pneumopericardium. 

Acute  Endocarditis. 

Under  this  heading  are  classified  first,  all  deaths  reported  defi- 
nitely as  caused  by  acute  endocarditis  or  acute  myocarditis ;  second, 
all  deaths  of  persons  under  60  years  of  age  for  whom  "endocar- 
ditis" (without  qualification)  or  "myocarditis"  (without  qualifi- 
cation) were  returned  as  the  cause  of  death;  third,  cases  of  in- 
fective endocarditis,  malignant  endocarditis  and  septic  endocarditis 
reported  with  no  additional  information  as  to  primary  causative 
factors.  The  title  heading  "acute  endocarditis"  as  used  in  the 
International  List  of  Causes  of  Death  is  a  distinct  misnomer,  since 
under  this  title  are  classified  also  deaths  from  myocarditis  which 
is  an  inflammation  of  the  myocardium  or  muscular  walls  of  the 
heart,  whereas  endocarditis  is  an  inflammation  of  the  endocardium 
or  lining  membrane  of  the  heart.  A  better  title  heading  for  the 
conditions  included  here  would  be  acute  infectious  endocarditis  and 
myocarditis. 

Nevertheless,  5,080  deaths  of  Metropolitan  Industrial  policy- 
holders  were  classified  under  this  heading  during  the  sexennium 
1911  to  1916.  The  death  rate  for  the  period  was  9.4,  and  although 
there  has  been  no  pronounced  change  from  year  to  year,  there  has 
been  a  slight  upward  trend  in  the  rate.  The  annual  average  for 
the  last  three  years  of  the  six  year  period  is  much  higher  than  that 
for  the  first  three  years.  This  is  difficult  to  account  for  in  view 
of  the  fact  that  for  almost  all  of  the  other  unsatisfactory  and  indefi- 


276          MORTALITY   STATISTICS   OF  INSURED   WAGE   EARNERS 

nite  titles  we  have  observed  a  tendency  toward  an  apparent  decrease 
in  the  death  rate.  This  title  is  unsatisfactory  because  instances 
are  very  rare  indeed  in  which  acute  endocarditis  occurs  as  a  pri- 
mary disease.  Consequently,  whenever  it  is  reported  without  state- 
ment of  any  other  morbid  condition,  the  presumption  is  that  the 
name  of  the  etiological  entity  which  was  responsible  for  this  condi- 
tion was  not  mentioned  by  the  physician.  In  the  expanding  Regis- 
tration Area  of  the  United  States  since  1911  there  has  been  a  slight 
upward  trend  also  in  the  death  rate  for  acute  endocarditis.  Know- 
ing as  we  do  that  we  should  expect  the  opposite  trend  in  common 
with  that  for  other  indefinite  statements,  the  reason  for  the  increase 
in  the  rate  must  be  sought  elsewhere.  It  is  possible  that  the  num- 
ber of  forms  of  the  disease  which  are  encountered  as  primary  fac- 
tors is  actually  increasing.  This  may  be  true  especially  of  cases  in 
which  malignant  or  infectious  endocarditis  is  in  evidence  as  a  pri- 
mary disease  of  the  heart  lining  or  valves.  However  this  may  be, 
we  are  face  to  face  with  the  situation  that  this  is  almost  an  isolated 
instance  of  an  apparent  increase  in  the  death  rate  for  an  unsatis- 
factory title. 

Embolism  and  Thrombosis. 

Under  this  heading  are  classified  reports  of  embolism  and  of 
thrombosis  which  appear  with  no  statement  as  to  primary  cause. 
It  should  be  distinctly  understood,  however,  that  deaths  from  puer- 
peral embolism  and  from  embolism  due  directly  to  postoperative 
conditions  are  not  classified  under  this  heading,  but  in  the  first  in- 
stance under  the  puerperal  state,  and  in  the  second  under  the  title 
representing  the  cause  for  the  relief  of  which  the  operation  was 
performed. 

One  thousand  one  hundred  and  ninety-two  (1,192)  deaths  were 
classified  as  due  to  embolism  and  thrombosis  in  this  experience 
during  the  period  1911  to  1916.  The  corresponding  death  rate 
was  2.2  per  100,000  exposed.  The  general  trend  of  the  mortality 
throughout  the  period  has  been  upward.  There  has  been  no  pro- 
nounced change,  however.  The  same  trend  is  observed  in  the  fig- 
ures for  the  expanding  Registration  Area  during  the  corresponding 
period.  In  the  Metropolitan  experience  the  death  rate  for  the 
colored  exposure  for  the  period  as  a  whole  (2.7)  was  in  excess  of 
that  for  white  policyholders  (2.1) ;  the  rate  for  white  females  (2.4) 
was  higher  than  that  for  white  males  (1.8) ;  for  colored  lives,  how- 


MISCELLANEOUS   DISEASES   AND   CONDITIONS.  277 

ever,  the  mortality  among  males  and  females  was  about  the  same, 
namely,  2.8  for  the  former  and  2.7  for  the  latter. 

Diseases  of  the  Larynx. 

The  greater  part  of  the  594  deaths  which  were  classified  under 
this  heading  during  the  period  1911  to  1916  were  reported  either 
as  due  to  laryngismus  stridulus,  laryngitis,  edema  of  glottis  or 
spasmodic  croup.  The  death  rate  for  the  period  was  1.1  per  100,- 
000  exposed  and  the  general  trend  throughout  the  sexennium  has 
been  slightly  downward.  This  is  also  true  of  the  expanding  Kegis- 
tration  Area  experience.  It  frequently  happens  that  deaths  re- 
ported by  physicians  under  the  several  terms  classified  under  "  dis- 
eases of  the  larynx"  represent  cases  which  were  actually  of  diph- 
theritic origin.  This  applies  particularly  to  deaths  reported  from 
"  laryngitis  "  which  were  caused  actually  by  diphtheritic,  fibrinous, 
membranous  or  pseudomembranous  laryngitis,  but  which  were  not 
so  stated  in  the  original  return  of  the  physician.  Much  of  the 
apparent  decline  in  the  death  rate  for  diseases  of  the  larynx  is 
doubtless  due  to  the  growing  tendency  of  the  medical  profession  to 
give  more  explicit  statements  of  these  causes,  thus  enabling  statis- 
tical offices  to  classify  them  as  deaths  caused  by  diphtheria. 

Pulmonary  Congestion,  Pulmonary  Apoplexy. 

Under  this  heading  939  deaths  of  Metropolitan  Industrial  policy- 
holders  were  classified  during  the  period  1911  to  1916.  The  death 
rate  for  the  sexennium  was  1.7  per  100,000  exposed  and  the  appar- 
ent trend,  as  shown  by  the  figures  relating  to  each  year  of  the 
period,  is  distinctly  downward.  The  same  apparent  downward 
trend  is  in  evidence  for  the  figures  relating  to  the  general  popula- 
tion. In  fact,  it  is  more  pronounced  in  the  latter  group  than  for 
the  insurance  experience. 

"  Pulmonary  congestion,  pulmonary  apoplexy "  is  an  extremely 
unsatisfactory  title  from  the  standpoint  of  mortality  statistics,  be- 
cause the  terms  listed  under  it  stand  for  conditions  which  are, 
almost  altogether,  mere  complications  or  terminal  symptoms  of 
other  diseases.  It  is,  as  a  matter  of  fact,  unfortunate  that  the 
rather  considerable  bulk  of  deaths  reported  in  this  way  should  be- 
come a  part  of  the  grand  total  recorded  as  due  to  diseases  of  the 
respiratory  system.  Many  of  these  reports  are  received  for  cases 


278          MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

in  which  the  return  is  " pulmonary  edema"  or  "pulmonary  con- 
gestion," and  in  which  these  conditions  were  terminal  to  cases  of 
cardiac,  renal  or  other  diseases.  The  apparent  decline  in  the  death 
rate  both  among  the  insured  group  and  in  the  general  population 
experience  is  accounted  for  largely  by  better  certification  of  primary 
diseases. 

The  great  majority  of  the  deaths  charged  to  this  title  were  re- 
ported as  due  to  pulmonary  apoplexy,  pulmonary  congestion,  pul- 
monary edema,  hypostatic  pneumonia  and  terminal  pneumonia. 

Asthma. 

Under  this  title  were  classified  the  very  considerable  total  of 
1,594  deaths  during  the  sexennium  1911  to  1916.  This  corre- 
sponds to  a  death  rate  of  3.0  per  100,000  exposed.  There  has  been 
a  continuous  decline  in  the  rate  throughout  the  years  which  con- 
stitute the  period  covered  by  this  experience.  The  rate  for  the  final 
year,  1916  (2.5),  represents  a  decline  of  30.6  per  cent,  from  that 
shown  for  the  earliest  year,  1911  (3.6).  This  decline  is  not  in 
evidence  in  the  published  figures  for  the  general  population,  for 
which  an  almost  uniform  death  rate  is  exhibited  throughout  the 
sexennium.  The  apparent  decline  shown  in  the  figures  for  the 
insured  group  is  due,  in  considerable  part,  to  the  rather  rigid  cen- 
sorship exercised  concerning  reports  of  "  asthma  "  from  the  mining 
districts,  with  the  result  that  many  of  these  returns  have  been  iden- 
tified as  relating  to  cases  of  miners' asthma.  These  deaths  are  classi- 
fied under  another  title  of  the  International  List  of  Causes  of  Death. 
A  number  of  these  reports,  moreover,  would  have  been  classified  as 
cardiac  asthma  and  assigned  to  organic  diseases  of  the  heart,  and 
still  others  would  have  been  assigned  to  Bright's  disease  as  cases  of 
renal  asthma,  if  strictly  accurate  returns  had  been  made.  The 
deaths,  therefore,  which  go  to  make  up  this  total  of  1,594  fatal  cases 
represent,  for  the  most  part,  reports  of  "asthma,"  without  qualifi- 
cation, and  also  returns  of  "  bronchial  asthma  "  concerning  both  of 
which  no  additional  data  were  available.  The  title  is  very  unsatis- 
factory because  it  is  intended  to  be  limited  to  the  disease  known  as 
bronchial  or  spasmodic  asthma.  Unfortunately  the  term  "asthma" 
is  used  loosely  by  .physicians  in  other  conditions  associated  with 
dyspnea.  In  the  Metropolitan  experience  the  death  rate  for  the 


MISCELLANEOUS   DISEASES   AND    CONDITIONS.  279 

colored  exposure  (6.0)  is  more  than  double  that  for  white  persons 
(2.5).     There  is  no  marked  sex  incidence  shown  among  the  insured. 

"  Other  Diseases  of  the  Respiratory  System." 

Under  the  above  heading  are  classified  a  considerable  number  of 
terms  which  are  not  assignable  to  any  of  the  diseases  of  the  respira- 
tory system  for  which  a  separate  statement  of  mortality  is  provided 
in  the  International  List  of  Causes  of  Death.  It  is  known  as  a 
"  residual "  title,  and  like  all  others  of  this  kind,  it  provides  for  the 
classification  of  a  number  of  vague  and  indeterminate  reports. 

It  should  be  understood  that  tuberculous  conditions,  if  known, 
are  not  classified  under  this  title  heading.  In  the  Metropolitan 
experience  the  majority  of  the  deaths  classified  here  were  reported 
as  follows,  there  being  no  further  definitive  data  available :  abscess 
of  lung,  chronic  pneumonia,  "  disease  of  lung,"  hemoptysis,  hemor- 
rhage of  lung,  interstitial  pneumonia,  miner's  asthma,  and  pneu- 
mokoniosis. 

Under  this  heading  888  deaths  of  Metropolitan  Industrial  policy- 
holders  were  registered  during  the  period  1911  to  1916,  correspond- 
ing to  a  death  rate  of  1.7  per  100,000  exposed.  Comparison  of  the 
death  rates  for  the  several  years  constituting  the  six  year  period 
shows  a  marked  downward  trend,  to  which  no  significance  whatever 
should  be  attached  except  as  an  evidence  of  the  increasing  accuracy 
of  reporting  causes  of  death  and  of  the  greater  care  with  which 
these  reports  are  inspected  from  year  to  year.  The  result  is  that 
reports  of  the  very  vague  and  indeterminate  conditions  listed  under 
this  title  are  being  to  a  greater  extent,  year  after  year,  transferred 
to  more  specific  and  satisfactory  headings.  This  apparent  down- 
ward trend  in  the  death  rate  is  also  shown  in  the  Census  reports 
covering  the  mortality  of  the  general  population. 

Diseases  of  the  Pharynx. 

One  thousand  one  hundred  and  fifty-three  (1,153)  deaths  of 
Industrial  policyholders  were  reported  from  diseases  of  the  pharynx 
during  the  six  year  period  1911  to  1916.  The  death  rate  for  the 
sexennium  was  2.1  per  100,000  exposed.  The  general  trend  of  the 
mortality  among  the  insured  during  the  sexennium  was  upward. 
This  was  practically  continuous.  The  minimum  was  shown  for  the 
earliest  year,  1911  (1.6),  and  the  maximum  for  the  latest  year, 


280          MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 

1916  (2.6).  The  same  rising  tendency  of  the  death  rate  is  shown 
by  the  figures  for  the  general  population.  There  was  no  pro- 
nounced color  incidence  in  the  Metropolitan  experience  although 
the  rate  for  colored  policyholders  (2.4)  exceeded  slightly  that  for 
the  white  (2.1).  The  number  of  deaths  of  colored  persons  in- 
volved, however  (159),  was  rather  too  small  to  be  significant. 
Among  the  white  insured  the  death  rate  for  males  (2.5)  exceeded 
that  for  females  (1.7) ;  among  the  colored  policyholders  the  rate 
for  the  females  (2.6)  was,  on  the  other  hand,  higher  than  that  for 
males  (2.1). 

The  greater  part  of  the  deaths  charged  to  diseases  of  the  pharynx 
were  reported  as  follows:  "disease  of  throat,"  Ludwig's  angina, 
pharyngitis,  quinsy,  tonsillitis,  or  Vincent's  angina. 

"Other  Diseases  of  the  Stomach  (Cancer  Excepted)." 

The  very  considerable  total  of  4,921  deaths  of  Industrial  policy- 
holders  was  reported  as  due  to  the  various  diseases  and  conditions 
which  must  be  classified  under  the  above  title  heading  according  to 
the  stipulations  of  the  International  List  of  Causes  of  Death.  This 
number  of  deaths  corresponded  to  a  death  rate  of  9.1  per  100,000 
exposed.  There  has  been  a  continuous  decline,  however,  through- 
out the  six  years  covered  by  this  report,  from  a  maximum  of  11.0 
for  1911,  the  earliest  year,  to  a  minimum  of  7.6  for  1916,  the  latest 
one.  An  even  more  pronounced  downward  trend  has  been  shown 
by  the  figures  for  the  general  population  during  the  same  period. 
The  apparent  decrease  in  the  death  rate  is  due  to  more  accurate 
reporting  of  causes  of  death  in  the  later  years  as  compared  with  the 
earlier  ones,  together  with  more  rigid  questioning  of  the  reports  on 
the  part  of  registration  offices. 

Under  this  title  are  listed  such  terms  as:  gastritis,  gastric  ca- 
tarrh, "disease  of  stomach,"  "acute  indigestion,"  "indigestion" 
and  a  number  of  others  which,  as  a  rule,  are  worse  than  worthless 
as  statements  of  the  primary  cause  of  death.  These  terms  are  used 
carelessly  when  they  relate  to  various  fatal  affections  in  which  in- 
flammation or  irritation  of  the  stomach  is  a  complication.  Deaths 
so  reported  are  found  on  investigation,  very  frequently,  to  be  charge- 
able to  such  conditions  as  alcoholism,  organic  heart  disease,  gastric 
ulcer,  gastroenteritis,  and  other  diseases  and  conditions  rather  than 
to  the  above  title.  As  is  apt  to  be  the  case  with  these  residual 


MISCELLANEOUS   DISEASES    AND    CONDITIONS.  281 

titles,  where  careless  and  incompetent  reporting  of  cause  of  death 
is  so  important  a  factor  in  influencing  the  death  rate,  the  rate  for 
colored  policyholders  is  very  greatly  in  excess  of  that  for  whites. 
In  the  Metropolitan  experience  the  actual  number  of  deaths  of  col- 
ored persons  assigned  to  "  other  diseases  of  the  stomach  "  was  1,563 
with  a  corresponding  death  rate  of  23.3  per  100,000  exposed. 
There  were  3,358  deaths  of  white  insured  with  a  rate  of  7.1  or  less 
than  one  third  the  rate  for  the  colored.  There  was  no  marked  dif- 
ference in  the  rates  for  males  and  females  among  the  whites,  the 
rate  for  the  former  being  6.9  and  for  the  latter  7.3.  Among  the 
colored  policyholders,  however,  the  mortality  among  the  females 
was  considerably  in  excess  of  that  among  the  males  (25.6  as  com- 
pared with  20.6). 

The  terms  which  follow  will  indicate  the  manner  in  which  the 
majority  of  the  deaths  charged  to  this  title  were  reported  in  the 
Metropolitan  experience.  It  should  be  understood  that  in  each 
case  no  further  information  was  available  on  the  basis  of  which  it 
could  be  classified  under  a  more  definite  and  satisfactory  title: 
abscess  of  stomach,  catarrh  of  stomach,  catarrhal  gastritis,  conges- 
tion of  stomach,  "disease  of  stomach"  (unqualified),  dyspepsia, 
gastritis,  hemorrhage  of  stomach,  indigestion,  acute  indigestion, 
and  pyloric  stenosis  (noncancerous  or  unqualified).  Although  it 
is  plainly  indicated  in  the  title  heading  that  cancer  of  the  stomach 
is  not  included  here,  it  is,  perhaps,  well  to  emphasize  the  fact  by 
restating  it  and  to  direct  attention  to  Title  No.  40  (cancer  and 
other  malignant  tumors  of  the  stomach  and  liver)  under  which 
deaths  from  malignant  gastric  growths  are  classified.  It  is  possible 
only  to  speculate  as  to  how  much  unrecognized  cancer  is  concealed, 
under  the  title  "  other  diseases  of  the  stomach." 

Biliary  Calculi. 

Under  the  above  title  were  classified  1,591  deaths  in  the  Metro- 
politan Industrial  experience  during  the  six  year  period  1911  to 
1916.  The  corresponding  death  rate  was  3.0  per  100,000  exposed. 
A  very  slight  upward  trend  was  shown  throughout  the  six  year 
period.  This  same  upward  trend  was  shown  for  the  general  popu- 
lation experience.  In  both  experiences  it  is  accounted  for,  in  all 
probability,  by  increasing  precision  in  statement  of  causes  of  death 
rather  than  by  any  actual  increase  in  deaths  caused  by  biliary  cal- 


282          MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

euli.  For  this  disease  the  death  rate  of  white  persons  is  consid- 
erably higher  than  that  for  the  colored,  while  the  rate  for  females 
in  both  the  white  and  colored  experiences  is  very  much  higher  than 
for  males.  White  females  show  a  death  rate  of  4.9  per  100,000 
exposed  for  the  period  1911  to  191 6,  which  is  almost  five  times  that 
for  white  males  (1.0);  for  the  colored  the  female  rate  (2.4)  is 
double  that  for  the  males  (1.2). 

The  greater  part  of  the  deaths  charged  to  biliary  calculi  were 
reported  in  the  Metropolitan  experience  under  the  following  terms : 
biliary  calculus,  biliary  colic,  cholelithiasis,  and  gall  stones. 

"Other  Diseases  of  the  Liver" 

Under  this  heading  the  very  considerable  total  of  2,181  deaths 
were  classified  during  the  sexennium  1911  to  1916.  The  death 
rate  was  4.1  per  100,000  exposed  for  the  period.  Included  here  are 
the  various  noncancerous,  nontuberculous  and  nonsyphilitic  hepatic 
and  gall-bladder  affections  for  which  the  International  List  of 
Causes  of  Death  does  not  provide  a  separate  classification.  The 
causes  of  death  assigned  to  this  title  were  reported,  in  the  main,  as 
follows:  abscess  of  liver,  atrophy  of  liver,  cholemia,  cholangitis, 
cholecystitis,  disease  of  liver  (unqualified),  hepatitis,  hypertrophy 
of  liver,  icterus,  and  jaundice. 

There  has  been  a  fairly  consistent  decline  in  the  death  rate 
throughout  the  period  covered  by  this  report.  A  similar  downward 
tendency  is  shown  in  the  reports  covering  the  mortality  for  the  gen- 
eral population  experience  although  the  downward  trend  there  is 
not  as  marked  as  that  shown  for  the  insured.  In  each  case  the 
decline  in  the  death  rate  is  doubtless  due  more  to  increasing  accu- 
racy in  reporting  than  to  any  change  in  conditions  covering  actual 
fatal  cases  resulting  from  the  diseases  classified  under  this  title. 
In  the  Metropolitan  experience  the  colored  exposure  shows  a  death 
rate  considerably  in  excess  of  the  white.  The  sex  incidence,  how- 
ever, is  different  for  the  two  races.  Among  white  insured  wage 
earners  the  rate  for  females  was  4.4  per  100,000  exposed,  as  com- 
pared with  3.0  for  white  males.  Colored  lives,  however,  show  a 
higher  rate  for  males  (6.4)  than  for  females  (5.8). 

Simple  Peritonitis  (Nonpuerpercd) . 

Under  this  very  unsatisfactory  heading  1,013  deaths  were  re- 
ported in  the  Metropolitan  experience  during  the  six  year  period 


MISCELLANEOUS   DISEASES   AND    CONDITIONS.  283 

1911  to  1916.  The  death  rate  was  1.9  per  100,000  exposed.  It  is 
desired  at  this  point  to  emphasize  the  fact  that  no  case  was  classi- 
fied under  this  heading  until  every  possible  effort  had  been  made  to 
ascertain  the  primary  cause  of  the  "  peritonitis/'  Experience 
shows  that  a  very  large  majority  of  the  deaths  which  physicians 
certify  as  due  to  "peritonitis"  are,  in  fact,  primarily  caused  by 
tuberculous  peritonitis,  appendicitis,  traumatism,  and  both  non- 
puerperal  and  puerperal  diseases  of  the  female  genitals.  Primary, 
idiopathic  peritonitis  is  rare  and  each  report  of  "peritonitis"  is  a 
suspicious  one  for  which  vital  statisticians  usually  seek  a  correction 
before  tabulating  the  death  under  this  heading.  The  1,013  deaths 
charged  to  this  title,  therefore,  represent,  in  the  main,  a  residue  of 
those  originally  certified  as  caused  by  "peritonitis"  and  concern- 
ing which  no  more  definite  information  could  be  obtained.  No 
significance  is  to  be  attached  to  the  declining  death  rate  shown  for 
the  insured  in  the  later  years  covered  by  this  report  as  compared 
with  the  earlier  ones.  The  decline  registers  simply  the  increasing 
tendency  to  report  cases  complicated  by  peritonitis  under  the  pri- 
mary cause  rather  than  under  the  terminal  symptom.  A  corre- 
sponding apparent  decline  in  the  death  rate  of  the  general  popula- 
tion is  shown  in  the  reports  covering  its  mortality.  The  decrease 
is  traceable,  to  a  very  great  extent,  to  the  same  cause.  Colored 
lives  show  a  mortality  more  than  triple  that  in  evidence  for  the 
whites  (4.7  per  100,000  exposed  as  compared  with  1.5).  In  the 
white  experience  the  rate  for  females  (1.9)  is  nearly  double  that 
for  males  (1.0) ;  in  the  colored  experience  the  mortality  assigned  to 
this  cause  for  females  was  6.6,  which  is  almost  treble  that  for  col- 
ored males  (2.4). 

Acute  Nephritis. 

Numerically,  acute  nephritis  is  an  important  cause  of  death  in 
the  Industrial  experience  of  the  Metropolitan  Life  Insurance  Com- 
pany, no  less  than  5,120  deaths  having  been  charged  to  it  during 
the  sexennium  1911  to  1916.  The  corresponding  death  rate  was 
9.5  per  100,000  exposed.  This  is  another  one  of  the  causes  of  death 
for  which  the  International  List  provides  a  separate  title  heading, 
but  which  by  no  means  constitutes  a  satisfactory  statement  of  cause 
of  death.  In  the  majority  of  deaths  in  which  acute  nephritis  is  a 
factor,  it  is  a  secondary  condition.  When  it  appears  as  the  sole 
statement  of  cause  of  death  the  report  is  always  more  or  less  sus- 


284          MORTALITY   STATISTICS   OF   INSURED   WAGE   EARNERS. 

picious,  the  strong  presumption  being  that  the  primary  causative 
factor  has  been  omitted  in  the  statement  of  the  physician.  Among 
the  principal  causes  of  acute  nephritis  are  exposure  to  cold,  as  well 
as  typhoid  fever,  malaria  and  syphilis.  Acute  poisonings  also 
often  bring  on  this  disease.  Whenever  it  is  reported,  without 
qualification,  in  connection  with  the  death  of  a  woman  of  child- 
bearing  age  it  is  more  than  probable  that  the  death  is  one  that 
should,  in  reality,  be  classified  under  the  head  of  those  due  to  puer- 
peral causes.  In  children  it  is  a  frequent  complication  of  the  acute 
contagious  or  infectious  diseases  such  as  scarlet  fever,  measles, 
diphtheria  and  even  chicken  pox.  The  5,120  fatal  cases  which  arc 
here  ascribed  to  this  disease  represent  a  mere  residue  of  those  origi- 
nally reported  as  having  been  caused  by  "acute  nephritis."  During 
the  latter  half  of  the  experience  period  particularly,  there  has  been 
rigid  inspection  of  such  reports  and  many  letters  of  inquiry  for 
the  primary  cause  have  been  sent  out  to  physicians.  The  replies 
which  have  been  received  together  with  the  growing  tendency  to 
report  primary  conditions  are,  more  than  any  other  factors,  respon- 
sible for  the  decline  in  the  death  rate  which  is  shown  when  com- 
parison is  made  of  the  rates  for  the  first  three  and  the  last  three 
years  of  the  sexennium,  1911  to  1916.  A  similar  apparent  decline 
in  the  death  rate  is  shown  by  the  published  figures  for  the  general 
population ;  but  this  decline,  like  that  for  the  Metropolitan  Indus- 
trial experience,  evidenced  better  reporting  and  improved  methods 
of  compiling  causes  of  death  rather  than  an  actual  decrease  in  the 
number  of  cases  in  which  "  acute  nephritis  "  was  the  primary  cause 
of  death. 

On  the  basis  of  the  5,120  deaths  that  remain  registered  under 
this  cause,  the  death  rate  for  the  colored  exposure  (17.9  per  100,000 
exposed)  was  more  than  double  that  for  the  whites  (8.3).  For 
white  insured  lives  the  mortality  among  males  (9.2),  was  consid- 
erably higher  than  that  for  females  (7.6).  Among  colored  lives, 
however,  there  was  little  difference  in  the  rates  for  the  sexes,  18.0 
for  males,  as  compared  with  17.8  for  females. 

"  Other  Diseases  of  the  Kidneys." 

Eight  hundred  and  sixty-one  (861)  deaths  of  Industrial  policy- 
holders  were  charged  to  "other  diseases  of  the  kidneys"  during 
the  period  1911  to  1916.  This  corresponds  to  a  death  rate  of  1.6 


MISCELLANEOUS   DISEASES   AND    CONDITIONS.  285 

per  100,000  exposed.  No  pronounced  change  is  shown  for  any 
year  of  the  period  as  compared  with  other  years,  the  death  rate 
being  fairly  stationary.  This  is  also  true  in  the  general  popula- 
tion experience,  although  the  death  rate  for  this  group  of  diseases 
is  slightly  higher  in  the  general  population  than  among  the  insured. 
Comparison  of  color  and  sex  rates  among  the  policyholders  shows 
that  the  mortality  in  the  colored  exposure,  2.4  per  100,000  exposed, 
was  rather  in  excess  of  that  for  the  white  group  (1.5).  For  white 
lives,  however,  the  death  rate  for  females  (1.6)  was  a  little  higher 
than  that  for  males  (1.4) ;  this  is  contrary  to  the  experience  in  the 
colored  exposure,  for  which  the  male  rate  was  2.8  as  compared  with 
2.0  for  the  females. 

Diseases  of  the  Bladder. 

Under  this  heading  611  deaths  of  Metropolitan  policyholders 
were  classified  during  the  period  1911  to  1916.  The  death  rate  for 
the  period  as  a  whole  was  1.1  per  100,000  exposed;  a  fairly  con- 
tinuous downward  trend  is  in  evidence  throughout  the  period.  It 
should  be  stated  that  this  title  does  not  include  cancer  of  the  blad- 
der, tuberculosis  of  the  bladder,  bladder  conditions  of  gonococcic 
origin,  nor  vesical  calculus.  A  decline  in  the  death  rate  as  shown 
for  the  Metropolitan  experience  is  also  in  evidence,  and  even  more 
pronounced,  in  that  of  the  general  population.  This  is  due  to  the 
change  of  many  reports  to  the  titles  that  relate  to  gonococcus  in- 
fection, to  diseases  of  the  prostate,  and  to  cancer  and  tuberculosis. 
The  great  majority  of  the  fatal  cases  classified  under  this  title  were 
reported  as  due  to  cystitis,  retention  of  urine,  rupture  of  the  blad- 
der, tumor  of  the  bladder  (noncancerous  or  unqualified)  and  abscess 
of  the  bladder.  The  rate  for  colored  lives  (2.2  per  100,000  ex- 
posed) is  more  than  double  that  for  white  lives  (1.0)  and  for  both 
the  colored  and  the  white  experiences  the  death  rate  for  males  was 
about  three  times  that  for  females. 

Diseases  of  the  Prostate. 

The  diseases  of  the  prostate  gland,  exclusive  of  those  certified  as 
due  to  tuberculous,  cancerous,  syphilitic,  or  traumatic  causes,  were 
reported  as  causes  of  1,162  deaths  among  Metropolitan  Industrial 
policyholders  during  the  sexennium  to  which  this  report  relates. 
The  corresponding  death  rate  was  2.2  per  100,000  exposed.  There 


286          MORTALITY   STATISTICS   OF   INSURED   WAGE   EARNERS. 

was  no  pronounced  variation  during  the  six  year  period.  The  rate 
for  the  period  as  a  whole  and  for  each  of  the  several  years  which 
constitute  it,  is  lower  than  that  for  the  general  population.  This 
is  due  to  the  fact  that  a  very  great  majority  of  the  deaths  caused 
by  prostatic  troubles  are  those  of  men  in  the  higher  age  groups. 
Ordinarily,  very  close  to  90  per  cent,  of  the  mortality  from  these 
diseases  is  among  men  over  sixty  years  of  age.  On  account  of  the 
comparatively  low  exposure  among  the  insured  at  these  ages,  a 
higher  death  rate  is  to  be  expected  in  the  general  population  expe- 
rience. The  mortality  among  colored  men  for  the  six  year  period 
was  7.7  per  100,000  exposed,  which  is  almost  double  the  rate  for 
the  white  insured  (4.3). 

Uterine  Tumor  (Noncancerous). 

Under  this  heading  are  classified  all  uterine  growths  which  are 
not  reported  as  due  to  cancer.  The  number  of  deaths  charged  to 
this  cause  in  the  Metropolitan  Industrial  experience  during  the 
sexennium  1911  to  1916,  was  1,'335,  corresponding  to  a  death  rate 
of  2.5  per  100,000  exposed.  Little  change  is  shown  throughout  the 
period  when  the  rates  for  the  individual  years  are  compared.  The 
death  rate  in  the  general  population  experience  is  lower  for  each 
year  of  the  period,  but,  like  that  for  the  insured,  there  is  little  fluc- 
tuation from  year  to  year.  The  great  bulk  of  deaths  charged  to 
this  condition  occurred  between  the  ages  of  25  and  55  years — in 
fact,  1,103  or  82.6  per  cent,  of  the  1,335  deaths  were  those  of  women 
in  this  age  group.  The  difference  in  the  rates  for  the  Metropolitan 
and  the  expanding  Registration  Area  experience  is  accounted  for 
largely  by  the  different  race  composition  of  the  two  populations. 
The  death  rate  among  colored  women  is  much  higher  than  among 
the  whites — over  six  times  as  high ;  the  rates  for  the  two  races  being 
17.3  and  2.7  per  100,000  exposed  respectively.  The  proportion  of 
colored  policyholders  to  the  total  number  of  policyholders  is  far 
greater  than  the  proportion  of  the  colored  population  of  the  ex- 
panding Registration  Area  is  to  its  total  population.  We  would, 
therefore,  expect  a  higher  death  rate  among  the  insured. 

"Other  Diseases  of  the  Uterus" 

Under  this  heading  are  classified  deaths  actually  caused  by  non- 
cancerous,  nontuberculous  and  nonpuerperal  diseases  of  the  uterus, 


MISCELLANEOUS   DISEASES    AND    CONDITIONS.  287 

together  with  certain  others  which,  if  correctly  certified,  would  have 
come  under  cancer,  tuberculosis,  or  puerperal  causes.  The  latter 
group  are  placed  under  the  unsatisfactory  title,  "  other  diseases  of 
the  uterus  "  because  all  of  the  information  which  physicians  might 
have  given  did  not  appear  in  their  statements.  The  deaths  classi- 
fied under  this  heading  were  returned,  in  the  main,  under  one  of 
the  following  designations:  abscess  of  uterus,  disease  of  uterus 
(with  no  further  qualification),  endometritis,  inflammation  of 
uterus,  menopause,  metritis,  pelvic  abscess,  pelvic  cellulitis  and 
prolapse  of  uterus. 

There  were  786  such  reports  during  the  period  1911  to  1916,  cor- 
responding to  a  death  rate  of  1.5  per  100,000  exposed.  Eather  a 
pronounced  apparent  downward  trend  is  shown,  which  means  that 
the  growing  tendency  to  make  full  and  complete  reports  has  brought 
about  more  certifications  under  the  head,  chiefly,  of  diseases  inci- 
dental to  pregnancy  and  childbirth. 

Salpingitis,  Other  Diseases  of  the  Female  Genital  Organs. 

One  thousand  seven  hundred  and  eighty- two  (1,782)  deaths  of 
insured  women  were  classified  under  this  heading  during  the  period 
1911  to  1916.  The  death  rate  was  3.3  per  100,000  exposed,  and 
there  was  very  little  variation  throughout  the  sexennium.  Com- 
parison with  the  figures  for  the  general  population  shows  that, 
while  the  death  rate  for  the  latter  was  the  lower,  the  same  absence 
of  any  material  fluctuation  from  year  to  year  is  to  be  observed. 
The  comparatively  high  death  rate  among  insured  women  is  due, 
largely,  to  the  fact  that  there  is  a  higher  proportion  of  colored 
women  among  them.  In  the  experience  for  the  insured,  the  mor- 
tality among  colored  women  from  these  diseases  has  been  about 
four  times  that  for  the  whites.  Practically  90  per  cent,  of  the 
deaths  are  those  of  women  between  the  ages  of  20  and  50  years. 

Under  this  heading  are  classified  all  deaths  caused  by  the  non- 
venereal,  noncancerous,  nontuberculous,  and  nonpuerperal  diseases 
of  the  female  genital  organs  for  which  separate  headings  are  not 
provided  by  the  International  List  of  Causes  of  Death.  The  great 
majority  of  the  deaths  classified  under  this  heading  were  reported 
under  one  of  the  following  terms:  abscess  of  Fallopian  tube,  ab- 
scess of  ovary,  disease  of  genital  organs  (unqualified),  disease  of 
ovary  (unqualified),  disease  of  Fallopian  tube  (unqualified),  in- 


288          MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 

flammation  of  Fallopian  tube,  inflammation  of  ovary,  ovaritis,  pus 
tube,  pyosalpingitis,  rupture  of  tube,  salpingitis,  and  tubo-ovarian 
abscess.  A  large  number  of  these  were,  undoubtedly,  either  of 
gonococcic  or  puerperal  origin.  They  were  not  so  defined  by  physi- 
cians, however,  and  the  1,782  cases  classified  under  "salpingitis, 
other  diseases  of  the  female  genital  organs  "  are  those  which  could 
not  be  definitely  identified  as  deaths  primarily  due  to  gonorrhea  or 
to  puerperal  causes. 

Gangrene. 

Under  this  very  unsatisfactory  heading  681  deaths  of  Metro- 
politan Industrial  policyholders  were  classified  during  the  six  year 
period  1911  to  1916.  This  corresponds  to  a  death  rate  of  1.3  per 
100,000  exposed.  The  death  rate  shows  an  apparent  decline 
throughout  the  period.  This  is  due,  largely,  to  improving  certi- 
fication of  causes  of  death  whereby  primary  causative  factors  in 
cases  of  gangrene  are  being  certified  by  physicians  to  a  greater 
extent  year  after  year.  In  consequence,  deaths  in  which  gangrene 
appears  as  a  complication  are  being  classified,  more  and  more,  under 
the  diseases  of  which  gangrene  is  a  complication.  The  same  appar- 
ent decline  in  the  death  rate  is  in  evidence  for  the  general  popula- 
tion, and  this  decline  is  doubtless  due  to  the  same  reason  as  that 
which  is  shown  for  the  Industrial  experience.  The  death  rate  for 
the  general  population  is  considerably  higher,  which  is  to  be  ex- 
pected on  account  of  the  age  distribution  of  the  two  populations, 
if  for  no  other  reason ;  for  a  very  great  majority  of  the  deaths 
charged  to  this  title  are  those  of  persons  over  60  years  of  age,  and 
this  class  does  not  constitute  as  great  a  proportion  of  the  Metropoli- 
tan exposure  as  it  does  of  that  of  the  general  population.  Again, 
a  report  of  "gangrene"  is  not  accepted  by  the  Metropolitan  Sta- 
tistical Bureau  for  classification,  without  investigation  as  to  the 
primary  cause.  In  consequence  of  this  rather  rigid  censorship,  a 
very  considerable  number  of  deaths  originally  certified  as  due  to 
gangrene  have  been  transferred  to  other  titles,  chief  among  which 
are  diseases  of  the  arteries,  embolism  and  thrombosis,  diabetes  and 
many  of  the  several  titles  which  come  under  the  general  class  head- 
ing "  External  Causes." 

Old  Age. 

This  is  one  of  the  most  unsatisfactory  title  headings  in  the  Inter- 
national List  of  Causes  of  Death.  The  several  terms  listed  under 


MISCELLANEOUS   DISEASES   AND   CONDITIONS.  289 

this  title,  such  as,  "  senility,"  "  old  age,"  "  senile  debility,"  "  senile 
degeneration,"  "senile  weakness"  and  others  have  too  often  been 
used  in  cases  of  old  people  who  died  of  more  or  less  well  defined 
organic  disease.  Fortunately,  however,  this  practice  is  steadily 
falling  into  disuse  and  the  death  rate  for  old  age  is  seemingly  de- 
clining. The  decrease  in  the  death  rate  in  .the  Metropolitan  In- 
dustrial experience  is  significant,  therefore,  only  as  it  represents  an 
improvement  in  the  quality  of  the  returns  from  year  to  year  and 
in  the  censorship  exercised  in  classifying  causes  of  death.  A  simi- 
lar decrease  in  the  apparent  death  rate  for  old  age  is  in  evidence  in 
the  mortality  reports  for  the  general  population  and  is  to  be  at- 
tributed to  the  same  causes.  The  published  death  rate  has  declined 
in  the  expanding  Registration  Area  from  50.4  in  1900  to  17.0  in 
1916. 

Three  thousand  four  hundred  and  eighty  (3,480)  deaths  of 
Metropolitan  Industrial  policyholders  were  charged  to  this  condi- 
tion during  the  six  year  period  1911  to  1916;  this  corresponds  to 
a  death  rate  for  the  period  of  6.5  per  100,000  exposed.  The  crude 
death  rate  for  old  age  among  the  insured  is,  of  course,  much  lower 
than  that  shown  for  the  Eegistration  Area,  the  obvious  reason 
being  the  difference  in  the  age  distribution  of  the  two  populations. 
A  much  smaller  exposure  proportionately  of  old  people  is  found 
among  the  insured.  The  death  rate  for  colored  lives  during  the 
period  (8.9)  is  higher  than  that  for  white  lives  (6.1)  and  for  each 
color  class  a  higher  death  rate  was  reported  for  females  than  for 
males. 

In  this  connection  it  is  of  interest  to  note  that  the  decrease  in 
the  death  rate  for  old  age  is  responsible  for  a  considerable  part  of 
the  supposed  increase  in  the  death  rates  of  some  of  the  "  degenera- 
tive diseases."  The  explanation  is  that  the  great  majority  of  the 
deaths  which,  under  conditions  of  five,  ten,  or  fifteen  years  ago, 
would  have  been  returned  as  due  to  "  old  age  "  or  its  synonyms,  are 
now  being  reported  by  more  careful  physicians  under  such  head- 
ings as  cerebral  hemorrhage,  arteriosclerosis,  organic  heart  dis- 
ease, etc. 

Ill-Defined  Diseases. 

Under  this  heading  of  the  International  List  of  Causes  of  Death 
are  classified  all  reports  which  are  not  returned  in  such  a  way  as 
to  permit  more  satisfactory  statistical  assignment.  The  great  ma- 

1    20 


290          MORTALITY   STATISTICS   OF   INSURED  WAGE   EARNERS. 

jority  of  the  deaths  classified  under  this  heading  consists  of  cases 
in  which  either  a  complete  diagnosis  was  not  made  or  reported,  or 
in  which  the  cause  of  death  was  absolutely  unknown  or  was  returned 
as  "unknown."  In  some  instances  there  was  no  medical  attend- 
ance. It  should  be  definitely  understood  that  none  of  the  deaths 
classified  under  this  title  in  this  report  was  so  assigned  without 
every  effort  having  been  made  to  obtain  a  more  definite  report. 
Many  hundreds  of  cases  in  which  the  vague  and  indeterminate  ex- 
pressions listed  under  this  class  were  encountered  in  the  original 
certifications  of  physicians  and  coroners  were  ultimately  classified 
under  more  definite  headings  as  a  result  of  corrections  made  by 
those  who  gave  the  original  reports.  The  general  improvement  in 
cause  of  death  certification  and  the  yearly  growing  number  of  these 
corrected  returns  are  the  sole  explanations  for  the  declining  death 
rate  which  is  in  evidence  for  this  class,  both  for  the  insured  and  for 
the  general  population. 

The  list  which  follows  shows  the  manner  in  which  the  great  bulk 
of  the  deaths  charged  to  this  class  were  reported:  dropsy,  cardiac 
syncope,  "dropped  dead,"  sudden  death,  asthenia,  atrophy,  bilious- 
ness, cachexia,  cardiac  asthenia,  cardiac  failure,  cardiac  paralysis, 
catarrhal  fever,  collapse,  coma,  complication  of  diseases,  congestion, 
debility,  decline,  disappearance,  dyspnea,  "fever,"  "found  dead," 
gastric  fever,  general  debility,  general  weakness,  heart  failure,  in- 
fection, inflammation,  inquest  pending,  malnutrition,  natural 
causes,  "  operation,"  paralysis  of  heart,  postoperative  shock,  pros- 
tration, shock,  surgical  operation,  surgical  shock,  "undetermined," 
"unknown,"  unknown  disease,  unspecified,  and  weakness. 

It  should  be  understood,  moreover,  that  not  all  of  the  ill-defined 
diseases  and  conditions  are  classified  here.  The  group  simply 
covers  the  worst  of  the  type,  It  will  be  well,  in  this  connection,  to 
read  what  is  said  about  unsatisfactory  reports  of  causes  of  death 
in  the  discussions  on  such  subjects  as  meningitis,  peritonitis,  pneu- 
monia, etc. 

Five  thousand  four  hundred  and  forty-eight  (5,448)  deaths  of 
Industrial  policyholders  were  charged  to  "ill-defined  diseases" 
during  the  period  1911  to  1916;  this  corresponds  to  a  death  rate  of 
10.1  per  100,000  exposed. 


SUPPLEMENT 


SUPPLEMENT. 
MORTALITY  STATISTICS  OF  INSURED  WAGE  EARNERS  DURING  1917. 

It  is  possible  at  the  present  time  to  present  a  general  statement 
on  the  mortality  experience  of  the  year  1917,  although  we  can 
show  only  the  facts  for  the  combined  experience  without  distinc- 
tion for  the  color,  sex  and  age  classes.  The  death  rate  in  the  aggre- 
gate during  1917  was  11.61  per  1,000  exposed.  This  is  based  upon 
a  total  of  125,955  deaths  and  an  exposure  of  10,847,852  years  of 
life.  The  mortality  experience  of  1917  according  to  causes  of 
death,  classified  under  the  titles  of  the  detailed  International  List, 
is  displayed  in  Table  176,  page  294. 

The  death  rate  from  all  diseases  and  conditions,  combined,  de- 
clined slightly  in  1917  from  the  figure  recorded  for  1916;  the  rates 
being  11.61  and  11.68  per  1,000  persons  exposed,  respectively. 
The  nine  months  of  war  in  1917  did  not,  therefore,  result  in  any 
increase  in  the  total  mortality.  Observation  will  show  also  that 
there  were  not  many  deaths  of  persons  in  military  or  naval  service 
from  causes  incidental  to  military  operations.  Such  deaths  as  oc- 
curred among  the  mobilized  American  forces  were  virtually  limited 
to  the  acute  infections  in  camps  in  the  United  States. 

Tuberculosis  was  the  chief  cause  of  death,  being  responsible  for 
16.3  per  cent,  of  all  deaths  in  1917.  The  death  rate  for  all  forms 
of  tuberculosis  was  188.9  per  100,000,  and  for  tuberculosis  of  the 
lungs  alone,  including  acute  miliary  tuberculosis,  172.3  per  100,- 
000  This  was  the  lowest  rate  recorded  for  this  disease  in  the 
mortality  experience  since  1911.  In  1916,  the  rate  was  172.8  per 
100,000.  The  difference  between  the  rates  for  these  two  years, 
however,  was  the  smallest  of  any  between  any  two  years  in  this 
experience,  which  indicates  a  slackening  in  the  downward  tendency 
of  the  mortality  in  recent  years. 

Organic  diseases  of  the  heart  followed  tuberculosis  in  order  of 
numerical  importance.  The  rate  was  142.0  per  100,000,  which  is 
higher  than  the  rate  for  the  six  year  period  1911  to  1916,  140.1. 
It  was  only  in  1912  that  the  death  rate  reached  a  higher  point, 
143.8. 

293 


294 


MORTALITY    STATISTICS   OF   INSURED   WAGE   EARNERS. 


to   «3 
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1917. 


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SUPPLEMENT. 


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MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


Exp 


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Bright's  disease 
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SUPPLEMENT. 


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*  Includes  urinary  abscess,  etc.  ||  Tuberculosis  excepted. 
•}•  Less  than  .05  per  100,000  exposed.  U  Tuberculosis  and  rheumatism  excepted. 
t  Cancer  excepted.  §  War  deaths  included. 

•*             CO        O»  N  «-H  1-1 

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Cause  of  Deatb. 

a 
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1 

2 

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Other  diseases  of  the  skin  and  annexa  .  . 
DISEASES  OF  THE  BONES  AND  OF  THE 

•  6 

l       ' 

i     il 

:    B  : 

ORGANS  OF  LOCOMOTION.  . 

•  o 
"o 

0} 

a 

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Diseases  of  the  bones  ||  .  .  . 
Diseases  of  the  joints'jf  .  . 
Amputations  
Other  diseases  of  the  orga 
tinn  .  . 

MALFORMATIONS.  .  .  . 

Congenital  malformations 
OLD  AGE  

Senility  

AFFECTIONS  PRODUCE 
NAL  CAUSES  §  

:1   : 

Suicide  (total)  
Rv  nnisnn  .  . 

.  a    . 

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a 

Diseases  of  the  prostate  
Nonvenereal  diseases  of  the  male  genita 

nrimns  .  . 

Uterine  hemorrhage  (nonpuerperal)  .  . 
Uterine  tumor  (noncancerous)  
Other  diseases  of  the  uterus  
Cysts  and  other  tumors  of  the  ovary  . 
Salpingitis  and  other  diseases  of  th 
female  genital  organs  
Nonpuerperal  diseases  of  the  breast  J. 

THE  PUERPERAL  STATE  

Accidents  of  pregnancy  
Puerperal  hemorrhage  
Other  accidents  of  labor  
Puerperal  septicemia  
Puerperal  albuminuria  and  convulsion! 
Puerperal  phlegmasia  alba  dolens,  em 
bolus,  sudden  death  
Following  childbirth  (not  otherwise  de 
fined  .  . 

Puerperal  diseases  of  the  breast  

DISEASES  OF  THE  SKIN  AND  OF  TH 
CELLULAR  TISSUES  

c 

I 

1 

c 

Furuncle  

1 

M 

10  co  t- 

IN  04  IN 

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0 

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! 

MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


SUPPLEMENT.  299 

The  cancer  death  rate,  and  especially  that  for  cancer  of  the 
breast,  was  nominally  stationary  during  1917.  The  slight  in- 
crease from  a  rate  of  70.3  per  100,000  in  1916  to  70.9  per  100,000 
in  1917  is  of  no  practical  significance.  The  average  cancer  death 
rate  of  the  preceding  six  calendar  years  was  70.0  per  100,000.  The 
1917  rate  of  70.9  per  100,000  was  reached  also  in  another  year  of 
the  preceding  six,  namely,  in  1915.  Among  wage  earners,  there  is 
no  evidence  that  cancer  is,  or  ever  has  been,  progressively  on  the 
increase.  The  death  rates  for  diabetes,  suicide  by  asphyxia,  sui- 
cide by  hanging  and  accidental  poisoning  also  remained  practically 
stationary  as  compared  with  the  figures  for  1916. 

Significant  Decreases  in  the  Death  Rates  for  Certain  Causes  of 
Death  during  1917. 

The  most  significant  fact  in  the  1917  experience  from  the  stand- 
point of  preventive  medicine  is  the  further  substantial  decline  in 
the  typhoid  fever  death  rate.  In  1917,  12.1  deaths  from  typhoid 
fever  occurred  per  100,000  persons  exposed.  This  rate  was  not 
quite  one-half  that  recorded  in  1911  (22.8  per  100,000).  The 
progressive  decline  in  the  death  rate  for  this  disease  is  ample  evi- 
dence of  the  growing  effectiveness  of  the  American  public  health 
movement  for  the  control  of  a  disease  which  was  once  a  scourge. 
A  fact  of  importance  in  the  present  mortality  experience  is  the 
continued  decline  of  the  death  rate  from  malaria.  In  1917  the 
rate  was  2.3  per  100,000  persons  exposed,  the  lowest  since  1911, 
when  6.1  deaths  from  malaria  were  recorded  for  each  100,000  per- 
sons exposed.  These  encouraging  facts  for  typhoid  fever  and  ma- 
laria mortality  are  evidence  also  of  the  effectiveness  of  visiting 
nursing  in  the  management  of  these  diseases  among  policyholders. 
A  large  number  of  cases  of  both  diseases  are  provided  each  year 
with  visiting  nurse  care  by  the  Company.  In  the  southern  states, 
especially  in  some  of  the  local  areas  where  nursing  service  is  avail- 
able for  policyholders,  malaria  and  typhoid  fever  are  of  the  first 
importance  as  causes  of  sickness.  Among  acute  cases  of  malaria 
and  among  typhoid  fever  patients  the  practical  bedside  care  given 
by  the  nurse  and'  the  accompanying  instructions  to  the  family  in 
hygiene  are  really  effective  for  life  saving.  Whooping  cough  mor- 
tality showed  a  decline  from  a  rate  of  5.8  per  100,000  in  1916  to 
a  figure  of  5.1  in  1917.  This  latter  figure  is  not,  however,  the 


300          MORTALITY   STATISTICS   OF   INSURED   WAGE   EARNERS. 

minimum  recorded  in  these  seven  years  of  medical  statistics  of 
Industrial  policyholders.  In  1915  the  whooping  cough  rate  was 
4.7  per  100,000. 

The  recorded  mortality  from  influenza  showed  a  decrease  to  a 
rate  of  14.4  per  100,000.  This  may  be  compared  with  a  figure  of 
23.8  for  1916,  which  was  the  highest  rate  for  the  seven-year  period, 
1911  to  1917.  Acute  poliomyelitis  showed  a  tendency  to  return  to 
its  usually  low  rate.  In  1917  there  were  recorded  1.6  deaths  from 
this  disease  per  100,000  policyholders  exposed.  The  rate  which 
we  may  usually  expect  is  approximately  1.2  per  100,000  persons 
exposed. 

Suicide  mortality  also  declined  during  1917,  although  slightly. 
The  suicide  death  rate  in  that  year  was  9.3  per  100,000  persons 
exposed  as  compared  with  a  rate  of  9.8  in  the  preceding  year,  with 
an  average  rate  of  12.2  per  100,000  for  the  six-year  period,  1911 
to  1916.  This  phase  of  the  suicide  mortality  experience  of  insured 
wage  earners  parallels  that  of  the  population  in  belligerent  and 
neutral  countries  abroad.  During  war  time,  the  suicide  death  rate 
of  the  civilian  population  usually  shows  a  significant  decrease. 
Deaths  from  accidental  drowning  showed  a  lower  rate  in  1917  (8.7 
per  100,000)  than  in  1916  (9.7  per  100,000).  Deaths  from  fall- 
ing occurred  at  a  rate  of  11.9  per  100,000  in  1917  as  compared 
with  a  figure  of  13.1  per  100,000  in  1916. 

Significant  Increases  in  the  Death  Rates  for  Certain  Causes  of 
Death  during  1917. 

A  small  number  of  the  more  important  causes  of  death  showed 
significant  increases  during  1917.  Both  measles  and  scarlet  fever 
had  higher  mortality  rates  than  during  1916.  Diphtheria  also 
registered  an  increase  of  nearly  four  points  per  100,000  over  the 
rate  for  the  year  1916.  The  1917  diphtheria  death  rate  was 
slightly  in  excess  of  the  average  for  the  preceding  six  years. 

The  increase  in  the  death  rate  from  pellagra  is  a  matter  of  some 
importance.  The  year  1916,  it  is  true,  showed  a  decrease  as  com- 
pared with  1915  and  1914;  but  in  1917  there  followed  a  rise  of 
about  14  per  cent.  It  was  remarked  in  the  section  given  over 
to  the  discussion  of  pellagra  in  the  preceding  pages  that  the  death 
rate  for  this  disease  in  the  South  seems  to  follow  the  level  of 
economic  prosperity  in  the  wage  earning  groups  of  the  population 


SUPPLEMENT.  301 

of  that  section  of  the  country.  The  increase  in  the  pellagra  death 
rate  for  the  year  1917  is,  perhaps,  an  indication  that  the  nutri- 
tional conditions  which  influence  the  development  of  the  disease  in 
the  first  place,  and  aggravate  its  course  in  the  second  place,  have 
returned,  approximately,  to  the  average  of  the  preceding  six  years. 
During  this  period  the  pellagra  death  rate  was  4.3  per  100,000 
persons  exposed.  The  upward  course  of  the  pellagra  death  rate 
throughout  1917  may  have  been  influenced  by  the  single  factor  of 
high  food  prices  brought  about  by  war  conditions. 

Mortality  from  pneumonia  (lobar  and  undefined)  showed  an 
increase  during  1917.  In  fact,  the  death  rate  for  this  disease  (88.8 
per  100,000)  was  higher  in  1917  than  in  any  of  the  preceding  six 
years  of  the  present  mortality  experience  except  1911.  This  rise 
in  the  pneumonia  rate  is  perhaps  best  explained  as  the  effect  of 
severe  weather  conditions  during  the  latter  part  of  1917.  Mortal- 
ity from  the  diseases  and  conditions  of  the  puerperal  state  like- 
wise showed  an  increase  from  a  figure  of  17.6  per  100,000  in  1916 
to  a  rate  of  18.2  in  1917.  The  rate  for  the  later  year  is,  however, 
considerably  under  the  average  for  the  preceding  six  years  (18.9 
per  100,000)  and  well  under  the  maximum  (20.0  per  100,000) 
observed  for  1913.  It  will  be  recalled  that  the  death  rate  for  dis- 
eases and  conditions  of  the  puerperal  state  in  1916  was  the  lowest 
on  record  in  the  present  study.  The  increase  in  the  death  rate 
for  diseases  and  conditions  associated  with  the  maternal  state  may 
be  accounted  for  largely  by  the  increase  in  mortality  from  puer- 
peral septicemia.  This  fact  of  increased  maternal  mortality  does 
not,  in  itself,  indicate  any  increase  in  the  fatality  rate  of  the  gra- 
vid and  parturient  state.  The  number  of  births  must  be  taken  into 
account.  A  further  inquiry  into  the  1917  maternal  mortality  ex- 
perience, with  this  latter  point  in  mind,  is  now  being  made. 

There  was  also  a  higher  death  rate  from  all  forms  of  accidents, 
combined,  during  1917  (76.5  per  100,000)  than  during  1916 
(73.2  per  100,000).  The  1917  total  accident  rate  is,  however, 
well  under  the  maximum  for  the  period  of  seven  years  under  ob- 
servation. This  maximum  rate  was  registered  in  1913,  a  figure 
of  77.6  per  100,000  persons  exposed.  The  increase  in  the  total 
accident  rate  seems  to  have  been  due  principally  to  increases  in 
that  for  automobile  accidents  and  injuries,  from  7.4  per  100,000  in 
1916  to  9.7  per  100,000  in  1917.  It  will  be  recalled  that  the  mini- 


302          MORTALITY   STATISTICS   OF   INSURED   WAGE    EARNERS. 

mum  rate  for  automobile  accidents  and  injuries  was  2.3  per  100,000 
in  1911  and  the  average  for  the  six  years,  1911  to  1916,  4.7  per 
1000,000.  The  automobile  is  gradually  assuming  the  proportions 
of  a  serious  menace  to  life,  especially  to  the  lives  of  children. 
Scarlet  fever  had  a  rate  in  1917  two-thirds  that  ascribed  to  the 
automobile. 

Steam  railroad  accidents  and  injuries  also  showed  an  increase 
during  1917  over  the  figure  for  the  preceding  year.  A  death  rate 
of  8.5  per  100,000  persons  exposed  was  recorded  in  1917  as  com- 
pared with  a  figure  of  7.9  per  100,000  in  1916. 


APPENDICES 


303 


304 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


APPENDIX  A. 

or  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OB 
Metropolitan  Life  Insurance  Company  Industrial 


lilt  -I  l>t 
Number. 

CMWC  of  Death. 

Ace  Period*. 

AU 
Me«—  1 

yr.  and 
over. 

1  to  4. 

6  U>0. 

10  to 
14. 

Ifi  to 
10. 

20  to 
24. 

1  to  189 
1  to  69 
1 
2 
3 
4 
6 

ALL  CAUSES  OF  'DEATH 
TOTAL      

635449 

252742 
267337 
63795 
61575 

58009 

27022 
24315 
3399 
3273 

2664516606 

12269    6981 
10946    6314 
1668<   1469 
1762    1842 

26655 

,10119 
9743 
2914 
3879 

35027 

12982 
13626 
MV2 
4757 

White  males          

White  females           

Colored  males  

Colored  females     

I.  GENERAL  DISEASES  

225112 

86277 
93966 
20077 
24792 

22751 

10401 
9917 
1205 
1228 

13306 

5690 
5744 
894 
978 

7191 

2226 
2932 
739 
1294 

13673 

4096 
6319 
1672 
2586 

19124 

6567 
7492 
2115 
2950 

White  females  

Colored  males          

Colored  females  

Typhoid  fever  

9011 

3380 
3297 
1088 
1246 

1 
1 

572 

231 
240 
45 
56 

936 

289 
379 
128 
140 

1065 

375 
390 
112 
188 

1495 

560 
544 
186 
206 

1275 

529 
457 
142 
147 

White  males          

White  females         

Colored  males  . 

Colored  females  

Typhus  fever  

White  males            

White  females         

Relapsing  fever  

8 

1 
2 
2 
3 

2295 

451 
495 
542 
807 

103 

36 
36 
15 
16 

1 

1 

2 

2 

... 

White  males  .  .       

White  females             

1 

i 

1 

i 

123 

32 
31 
17 
43 

4 

i 
i 

2 

Colored  males  

1 
1 

117 

23 
19 
31 
44 

10 

6 

1 

"4 

155 

26 
32 
42 
65 

8 

3 
3 
1 
1 

Colored  females  

Malaria  

293 

79 
77 
67 
70 

20 

7 
11 
1 
1 

235 

73 
67 
51 
54 

9 

7 
2 

White  males  

White  females  

Colored  males  

Colored  females  

Smallpox  

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


305 


APPENDIX  A. 

CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 
Number. 

26  to 
29. 

30  to 
34. 

35  to 
39. 

39907 

15390 
14346 
4965 
5206 

40  to 
44. 

45  to 
49. 

60  to 
64. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

36105 

13075 
13918 
4180 
4932 

37324 

14121 
13507 
4558 
5138 

40245 

16236 
14674 
4637 
4698 

41139 

16773 
15764 
4129 
4473 

46595 

18567 
18929 
4355 
4744 

50108 

20038 
21595 
3972 
4503 

55565 

21746 
25353 
3843 
4623 

53419 

20441 
26298 
2960 
3720 

43942 

16752 
22580 
2081 
2529 

28158 

10230 
15429 
1003 
1496 

1  to  189 
1  to  59 
1 
2 
3 
4 
5 

18915 

6771 
7127 
2171 
2846 

18027 

7078 
6219 
2175 
2555 

17943 

7314 
6254 
2177 
2198 

16478 

6883 
6075 
1797 
1723 

14721 

6039 
5899 
1323 
1460 

14784 

5761 
6458 
1195 
1370 

14257 

5439 
6664 
980 
1174 

13049 

4781 
6465 
748 
1055 

10408 

3678 
5529 
473 

728 

6907 

2419 
3790 
282 
416 

3578 

1134 
2082 
131 
231 

902 

348 
336 
91 
127 

664 

262 
205 
89 
108 

518 

182 
180 
75 
81 

426 

159 
164 
57 
46 

1 

1 

307 

113 
117 
41 
36 

294 

112 
94 
47 
41 

209 

89 
66 
24 
30 

168 

70 
56 
22 
20 

110 

39 
38 
21 
12 

48 

15 
20 
8 
5 

22 

7 
11 

4 

1 
1 

1 

1 

78 

15 

18 
17 
28 

2 

32 

7 
5 
9 
11 

145 

21 
26 
34 
64 

6 

1 
3 

i 

139 

21 
20 
42 
66 

4 

2 

1 
1 

122 

19 
23 
29 
51 

10 

5 
2 
2 
1 

114 

20 
19 

27 
48 

6 

2 
3 
1 

138 

23 
29 
39 
47 

4 

1 
2 
1 

160 

27 
33 
36 
64 

8 

4 
2 
2 

148 

16 
37 
37 
58 

6 

2 
3 

1 

159 

25 
36 
32 
66 

6 

137 

24 
33 
32 

48 

1 

1 
3 
2 

1 

1 
1 

306 


MORTALITY   STATISTICS   OF   INSURED   WAGE   EARNERS. 


NUMBER  OF  DEATHS  PROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


i  tin  i.  ist 
Number. 

Cause  of  Death. 

Age  Periods. 

All 
ages—  1 
yr.  and 
over. 

I  to4. 

5to9. 

10  to 
14. 

15  to 
10. 

20  to 
34. 

6 

7 
8 
9 
10 
11 
12 

Measles     

4776 

2242 
2200 
160 
174 

4638 

2273 
2211 
75 

79 

3075 

1007 
1447 
281 
340 

13089 

6373 
6112 
292 
312 

8056 

2411 
3611 
810 
1224 

1 

3661 

1791 
1657 
107 
106 

2210 

1140 
1010 
25 
35 

2666 

895 
1261 
236 
274 

6868 

3519 
3089 
141 
119 

589 

268 
244 
45 
32 

793 

354 
374 
30 
35 

1635 

818 
770 
27 
20 

354 

100 
161 
39 
54 

4808 

2297 
2303 
98 
110 

252 

98 
113 
23 
18 

112 

39 
55 

7 
11 

420 

176 

220 
16 
8 

28 

8 
8 
5 
7 

904 

379 
466 
26 
33 

158 

53 
65 
13 
27 

69 

28 
25 
9 

7 

171 

80 
80 
3 
8 

7 

1 
3 
1 
2 

182 

80 
84 
7 
11 

218 

74 
70 
29 
45 

32 

9 
17 
3 
3 

86 

27 
57 

2 

1 
1 

86 

33 
40 

7 
6 

254 

73 
91 
32 
58 

White  males                  

White  females  

Colored  males  .        

Colored  females  .       

Scarlet  fever                  

White  males  

White  females  

Colored  males                 

Colored  females        

Whooping  cough  

White  males  

White  females  .        

Colored  males  

Colored  females  

Diphtheria  and  croup  

White  males  

White  females  

Colored  males  

Colored  females  

Influenza  

White  males  

White  females  

Colored  males  

Colored  females  

Miliary  fever  .  .  ,  

White  males  

White  females  

Colored  males  

Colored  females  

1 
5 

2 
3 

Asiatic  cholera  

2 

1 

1 

... 

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


307 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

28 

4 
18 
2 
4 

41 

8 
30 
1 
2 

2 

24 

7 
15 

16 

2 
12 
1 

11 
1 

8 

9 

2 
6 

10 

3 

7 

4 

2 

1 
1 

4 

2 
1 

3 

1 
2 

2 

1 

1 

1 

6 
7 
8 
9 
10 
11 
12 

2 

2 

29 

8 
20 

1 

3 

1 
22 

7 
12 
1 
2 

2 

2 

8 

4 
4 

1 
5 

2 
1 
1 

3 
3 

3 

1 
2 

1 

1 

i 

2 

1 
2 
1 

2 

1 
2 

2 

1 
1 

2 
1 

1 

3 

2 

2 

1 

2 

1 

1 
60 

15 
34 
2 
9 

283 

67 
98 
48 
70 

1 

1 
10 

2 

7 

1 
5 

2 
2 

3 

1 

2 

50 

10 
28 
2 
10 

288 

80 
96 
52 
60 

36 

11 
18 
2 
5 

358 

109 
112 
68 
69 

23 

9 
10 
3 
1 

344 

105 
126 
51 
62 

26 

7 
13 
4 
2 

417 

124 
169 
49 
75 

13 

2 
9 

9 

3 
4 

6 

3 
3 

2 
603 

159 
254 
75 
115 

1 
747 

226 
317 
82 
122 

2 
902 

243 
423 
76 
160 

1042 

290 
531 
78 
143 

1 
945 

276 
509 
60 
100 

656 

166 
393 
29 
68 

1 

1 

1 

1 
1 

1 

1 

308 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  or  DEATHS  PROM   EACH  SPECIFIED  DISEASE   OB 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  Ltot 
Number. 

CmuM  of  Death. 

Age  Periods. 

All 

a*e»—  1 

yr.  And 
over. 

1  U>4. 

5  to  9. 

10  to 
14. 

IS  to 
19. 

20  to 
24. 

13 
14 
15 
16 
17 
18 
19 

Cholera  nostras  

190 

83 
74 
13 
20 

2029 

648 
848 
212 
321 

1 

32 

20 
9 

3 

526 

238 
226 
32 
30 

12 

4 
5 
2 

1 

84 

41 
31 
6 
6 

5 

4 
1 

4 
2 

White  males             

White  females               

Colored  males                      .... 

1 

1 

33 

4 
11 
5 
13 

Colored  females       

Dysentery  

18 

6 
6 
2 
6 

27 

10 
8 
2 
7 

White  males  

White  females        

Colored  males        

Colored  females  

Plague   

White  males  

White  females  

1 

Colored  males  

Colored  females  

Yellow  fever  

1 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Leprosy  

11 

5 
2 
2 
2 

2 

1 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Erysipelas  

1289 

596 
573 
62 
58 

184 

86 
81 
7 
10 

62 

24 
35 
2 
1 

98 

49 
43 

4 
2 

27 

16 
11 

21 

9 
11 
1 

41 

18 
18 
2 
3 

4 

2 
2 

44 

19 
19 

4 
2 

3 

2 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Other  epidemic  diseases  

42 

21 
17 
1 
3 

13 

2 

8 

3 

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


309 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  Ltot 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
30. 

40  to 
44. 

45  to 
49. 

50  to 
64. 

55  to 
69. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

76  and 
over. 

2 
1 

1 
51 

13 
13 
9 
16 

5 

a 

1 

2 
52 

17 
14 

7 
14 

4 

1 
2 

1 
56 

14 
11 
13 
18 

8 

3 
3 
2 

61 

11 
13 
18 
19 

7 

3 
3 

i 

73 

19 
33 
7 
14 

17 

4 
11 
1 

1 

122 

31 
45 
20 
26 

15 

7 
4 
3 

1 

138 

39 
52 
23 
24 

23 

11 
8 
1 
3 

206 

47 
88 
27 
44 

29 

13 
11 
2 
3 

241 

62 
115 
21 
43 

15 

6 
7 

1 

200 

59 
109 
12 
20 

1 

12 

2 
9 

1 
141 

37 
74 
8 
22 

13 
14 
15 
16 
17 
18 
19 

1 

1 
1 

1 
1 

1 

1 
1 

4 

2 
1 

1 

1 

1 

1 

112 

42 
59 
2 
9 

4 

1 
3 

48 

23 
19 
3 
3 

1 
73 

40 
23 
5 
5 

1 
1 

1 
143 

57 

68 
7 
11 

2 
1 

101 

46 
44 
7 
4 

3 

2 

1 

58 

19 
37 
1 
1 

2 
2 

85 

46 
32 
3 
4 

2 
2 

98 

52 

38 
7 
1 

1 
1 

116 

54 
49 
5 
8 

3 
1 

122 

60 
52 
8 
2 

2 
2 

138 

71 
58 
5 

4 

4 

1 
3 

1 

... 

1 

1 

310 


MORTALITY    STATISTICS   OF   INSURED   WAGE    EARNERS. 


NUMBER  or  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OB 
Metropolitan  Life  Insurance  Company  Industrial 


Int'l  MM 
Number. 

Cmuae  of  Death. 

Ace  Period*. 

All 
ages  —  1 
yr.  and 
over. 

1  to  4. 

fi  toO 

10  to 
14. 

15  to 
10. 

20  to 
24. 

20 

21 
22 
23 
24 
25 
26 

Purulent  infection  and 
Bepticeraia  

1083 

482 
427 
86 
88 

6 

3 
1 

84 

30 
48 
2 
4 

74 

40 
30 
3 

1 

57 

27 
25 
4 

1 

61 

31 
20 
4 
6 

70 

37 
29 
1 
3 

White  males  

White  females  .        

Colored  males           

Colored  females          

Glanders  

White  males  

White  females  .        

Colored  males             

2 

Colored  females          

A  n  thro*-  ,..,..,, 

27 

21 
6 

1 
1 

2 
2 

1 
1 

White  males  

White  females              

Colored  males  

Colored  females  

Rabies  

84 

54 
17 
7 
6 

890 

479 
188 
166 
57 

14 

10 
2 
1 
1 

2310 

352 
1010 
194 
754 

14 

9 
5 

16 

11 

4 
1 

19 

14 
2 
3 

9 

7 
2 

2 
2 

White  males     .        

White  females            

Colored  males                

Colored  females           ...        . 

Tetanus  

40 

23 
14 
2 
1 

1 
1 

210 

128 
52 
24 
6 

1 

1 

154 

99 
16 
31 
8 

1 
1 

71 

42 
8 
18 
3 

3 

2 
1 

47 

21 
9 
7 
10 

White  males  

White  females  

Colored  males  

Colored  females  

Mycoses  

White  males  

White  females  .        

Colored  males  

Colored  females         

Pellagra  

20 

4 
11 
3 
2 

24 

1 
8 
6 
9 

32 

4 

12 
7 
9 

67 

7 
25 
4 
21 

155 

7 
66 
7 
75 

White  males  

White  females  

Colored  males  

Colored  females  

APPEXDIX   A. 


311 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

75 

28 
33 
5 
9 

2 

1 
1 

67 

29 
24 
6 
8 

70 

31 
27 
9 
3 

1 
1 

72 

26 
29 
10 

7 

2 

68 

•26 
21 
14 

7 

83 

39 
25 
9 
10 

78 

38 
28 
4 
8 

87 

43 
32 
4 
8 

1 

65 

25 
25 
9 
6 

46 

21 
18 
2 
5 

26 

11 
13 

2 

20 
21 
22 
23 
24 
25 
26 

1 

2 

1 
1 

2 

1 
1 

2 
2 

1 
1 

2 
2 

5 

3 
2 

1 
1 

2 

1 
1 

3 
3 

2 
2 

2 

1 
1 

3 
2 

5 

3 
1 

4 

2 
1 

2 
2 

4 
1 

2 

i 

1 

39 

19 
6 
12 
2 

2 
2 

2 
1 

1 

1 

i 

1 
2 

34 

16 

7 
9 
2 

1 
1 

i 

19 

9 
7 
2 
1 

2 

1 

21 

7 
8 
5 
1 

1 
63 

29 
13 
16 
5 

1 
1 

48 

16 
11 

14 

7 

1 
54 

27 
13 
11 
3 

1 
45 

22 
12 
10 
1 

2 

1 

29 

12 
6 
4 

7 

12 

5 
6 
1 

4 
4 

1 

1 

207 

15 
93 

12 

87 

256 

25 
102 
16 
113 

278 

25 
130 
19 
104 

1 
280 

33 
135 
25 

87 

203 

24 
94 
21 
64 

219 

38 
101 
26 
54 

221 

57 
89 
19 
56 

177 

57 
74 
13 
33 

114 

34 
46 
8 
26 

46 

14 
18 
5 
9 

21 

7 
6 
3 
6 

312 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  or   DEATHS   FROM   EACH  SPECIFIED   DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  Ltot 
Number. 

CftUMOf   l)e»Ui 

Age  Period*. 

All 

tget-l 
yr.  and 
over. 

lto4. 

5  toO. 

lOto 
14. 

15  to 
10 

20  to 
24. 

27 
28  to  35 
28 
29 
30 
31 
32 

Beriberi  

4 

White  males     

2 
1 

White  females             

Colored  males  

Colored  females  

1 
110363 

45319 
37881 
13123 
14040 

93526 

39353 
31763 
10902 
11508 

6380 

2087 
2056 
1038 
1199 

4647 

1953 
1983 
357 
354 

3155 

791 
1179 
470 
715 

866 

381 
300 
104 
81 

Tuberculosis  —  all  forms  (total) 
White  males  

4095 

1669 
1583 
420 
423 

926 

277 
288 
171 
190 

263 

84 
89 
40 
50 

2324 

1038 
1017 
137 
132 

305 

131 

107 
44 
23 

107 

50 
42 
8 
7 

2742 

886 
963 
416 
477 

977 

202 
301 
220 
254 

202 

57 
65 
24 
56 

1008 

422 
426 
81 
79 

251 

73 
69 
52 
57 

140 

61 
51 
17 
11 

3053 

574 
1125 
461 
893 

1968 

258 
747 
307 
656 

257 

37 
86 
42 
92 

358 

135 
144 
32 
47 

213 

34 
66 
45 
68 

110 

51 
34 
11 
14 

10023 

2653 
3933 
1316 
2121 

8270 

2169 
3323 
1042 
1736 

867 

193 
315 
140 
219 

262 

96 
119 
31 
16 

324 

58 
92 
62 
112 

103 

48 
29 
14 
12 

15678 

5302 
6161 
1778 
2437 

13714 

4744 
5402 
1502 
2066 

1173 

321 
453 
164 
235 

183 

59 

87 
22 
15 

348 

70 
136 
52 
90 

75 

33 
19 
16 

7 

White  females  

Colored  males  

Colored  females  

Tuberculosis  of  the  lungs.  .  . 
White  males  

White  females  

Colored  males  

Colored  females  

Acute  miliary  tuberculosis.  . 
White  males  

White  females  

Colored  males  

Colored  females  

Tuberculous  meningitis.  .  .  . 
White  males  

White  females  

Colored  males  

Colored  females  

Abdominal  tuberculosis.  .  .  . 
White  males  

White  females  

Colored  males  

Colored  females  

Pott's  disease  

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


313 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PEEIOD. 
Mortality  Experience,  1911  to  1916. 

Age  Periods. 


Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

2 

2 

27 

1 

1 

, 

1 

1 

15309 

13844 

12466 

10043 

7303 

5554 

4260 

2992 

1742 

889 

370 

28  to  35 

5592 

5763 

5660 

5086 

3917 

3011 

2311 

1504 

870 

382 

139 

5739 

4583 

3873 

2892 

2034 

1535 

1243 

1011 

640 

385 

181 

1787 

1707 

1616 

1235 

813 

615 

444 

287 

133 

72 

23 

2191 

1791 

1317 

830 

539 

393 

262 

190 

99 

50 

27 

13719 

12511 

11286 

9140 

6704 

5093 

3868 

2690 

1554 

787 

319 

28 

5086 

5324 

5260 

4750 

3692 

2815 

2133 

1380 

795 

344 

124 

5192 

4142 

3479 

2613 

1816 

1386 

1119 

901 

564 

340 

150 

1547 

1497 

1414 

1072 

735 

548 

398 

250 

118 

59 

22 

1894 

1548 

1133 

705 

461 

344 

218 

159 

77 

44 

23 

960 

755 

657 

487 

290 

202 

121 

82 

37 

21 

6 

29 

300 

276 

255 

217 

126 

102 

57 

31 

18 

10 

3 

316 

221 

188 

116 

82 

43 

33 

29 

11 

7 

2 

156 

124 

126 

102 

44 

36 

20 

12 

5 

3 

188 

134 

88 

52 

38 

21 

11 

10 

3 

1 

1 

133 

85 

91 

64 

43 

28 

28 

20 

12 

5 

3 

30 

55 

33 

31 

28 

18 

11 

13 

9 

2 

2 

1 

51 

30 

35 

19 

14 

12 

8 

8 

8 

3 

2 

13 

11 

13 

8 

3 

2 

2 

1 

1 

14 

11 

12 

9 

8 

3 

5 

2 

1 

288 

278 

268 

223 

154 

135 

128 

105 

76 

37 

22 

31 

62 

53 

56 

48 

37 

44 

44 

36 

28 

11 

6 

107 

101 

116 

88 

75 

57 

52 

43 

35 

21 

14 

38 

44 

33 

36 

18 

15 

13 

14 

3 

1 

81 

80 

63 

51 

24 

19 

19 

12 

10 

4 

o 

65 

77 

46 

33 

29 

20 

18 

15 

13 

10 

5 

32 

25 

33 

19 

13 

11 

8 

12 

8 

4 

4 

1 

26 

30 

15 

14 

11 

11 

3 

5 

2 

4 

4 

10 

8 

6 

3 

3 

1 

2 

3 

2 

4 

6 

6 

3 

4 

1 

2 

4 

314 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


NUMBER  OF   DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


InflLtot 

Number. 

CauM  of  Death. 

Age  Perloda. 

AU 
age»-l 

yr.  and 
over' 

1  to4. 

6to9. 

10  to 
14. 

16to 
IB. 

20  to 
24. 

33 
34 

35 
36 
37 
38 
39  to  45 

'White  swellings       

573 

278 
185 
77 
33 

959 

395 
329 
125 
110 

257 

81 
86 
50 
40 

174 

43 
57 
36 

38 

4659 

1984 
1004 
988 
683 

200 

46 
71 
31 
52 

37666 

10784 
22736 
946 
3200 

54 

31 
14 
4 
5 

96 

49 
25 
11 
11 

20 

9 
1 
6 
5 

132 

28 
38 
34 
32 

116 

43 
30 
20 
23 

6 

4 
1 

169 

78 
83 

4 
4 

73 

40 
26 
5 
2 

74 

30 
21 
9 
14 

17 

1 
4 

8 

4 

20 

9 
5 
2 
4 

45 

18 
12 
7 
8 

2 
1 
1 

69 

30 
23 
11 
5 

63 

26 

18 
11 
8 

15 

3 
7 
2 
3 

4 

2 
1 

i 

41 

17 
9 
10 
5 

1 
1 

65 

34 
20 
8 
3 

97 

48 
27 
9 
13 

35 

7 
8 
10 
10 

2 

45 

23 
14 

7 
1 

104 

40 
35 
11 
18 

36 

12 
15 

4 
5 

1 

White  males  

White  females  

Colored  males  

Colored  females  

Tuberculosis  of  other 
organs           

White  males  

White  females  

Colored  males  

Colored  females  

Disseminated  tuberculosis.  . 
White  males  

White  females  

Colored  males  

Colored  females  

Rickets  

White  males  

White  females  

2 

1 

Colored  males  

Colored  females  

Syphilis  

80 

19 
24 
13 
24 

25 

4 
10 
2 
9 

169 

75 

77 
7 
10 

181 

56 
42 
36 

47 

28 

3 
13 
2 

10 

224 

99 
97 
4 
24 

White  males  

White  females  

Colored  males  

Colored  females  

Gonococcus  infection  

White  males  

White  females  

Colored  males  

Colored  females  

Cancer  and  other  malignant 
tumors  —  all  forms  (total)..  . 

White  males  

109 

51 
52 
3 
3 

91 

46 
42 
1 
2 

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


315 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 

25  to 

30to 

35  to 

40  to 

45  to 

50  to 

65  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

£9. 

64. 

69. 

74. 

over. 

37 

38 

27 

25 

29 

34 

31 

13 

17 

11 

r 

33 

20 

15 

9 

9 

12 

15 

18 

9 

8 

4 

1 

5 

15 

11 

10 

11 

12 

"i 

i 

8 

4 

3 

9 

6 

7 

J 

3 

7 

i 

4 

J 

1 

'. 

'. 

'. 

3 

4 

1 

77 

76 

68 

57 

43 

35 

58 

55 

29 

17 

10 

34 

28 

24 

22 

18 

16 

13 

32 

27 

13 

6 

3 

33 

31 

22 

26 

20 

13 

17 

19 

10 

6 

6 

10 

12 

12 

9 

7 

4 

7 

6 

3 

4 

6 

9 

12 

4 

5 

2 

3 

3 

1 

1 

30 

24 

23 

14 

11 

7 

8 

12 

4 

1 

35 

16 

5 

8 

3 

5 

3 

2 

4 

2 

1 

9 

13 

7 

6 

5 

1 

4 

4 

2 

4 

6 

5 

2 

2 

2 

1 

3 

3 

1 

1 

2 

2 

1 

2 

3 

3 

2 

2 

2 

36 

1 

1 

1 

1 

2 

2 

2 

2 

2 

1 

362 

505 

706 

665 

583 

526 

367 

249 

133 

73 

27 

37 

115 

191 

325 

268 

276 

245 

171 

126 

67 

31 

16 

71 

100 

.137 

145 

121 

123 

76 

58 

33 

18 

5 

85 

131 

150 

154 

114 

104 

82 

42 

21 

15 

4 

91 

83 

94 

98 

72 

54 

38 

23 

12 

9 

2 

26 

26 

31 

17 

11 

15 

4 

3 

5 

1 

38 

4 

3 

6 

5 

2 

10 

3 

2 

3 

14 

9 

10 

5 

3 

1 

1 

3 

6 

5 

4 

2 

3 

1 

1 

1 

5 

8 

10 

3 

4 

1 

1 

422 

910 

1891 

2866 

3925 

5205 

5783 

5913 

4901 

3384 

1704 

39  to  45 

103 

156 

284 

478 

851 

1346 

1711 

2007 

1697 

1222 

580 

219 

537 

1205 

1915 

2514 

3247 

3488 

3369 

2882 

1977 

1032 

19 

27 

64 

86 

105 

155 

146 

159 

88 

50 

28 

81 

190 

338 

387 

455 

457 

438 

378 

234 

135 

64 

316 


MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


NUMBER  OF   DEATHS   FROM   EACH  SPECIFIED  DISEASE  OK 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  I.  tat 
Number. 

CAUM  of  Death. 

Age  Period*. 

All 

ages  —  1 
yr.  and 
over. 

1  to  4 

5U>0 

10  to 
14. 

15to 
IB. 

20  to 
24. 

39 
40 
41 

42 
43 
44 
45 

Of  the  buccal  cavity  

1353 

989 
240 
75 
49 

14153 

5309 
7674 
494 
676 

4482 

1414 
2701 
103 
264 

7882 

6 

j 
S 

1 
20 

7 
13 

22 

14 
6 

4 

i 

1 
1 

11 

7 
3 

i 

12 

9 
3 

1 

1 
3 

7 

2 
5 

13 

9 
3 
1 

4 

4 
1 
1 

16 

6 
7 
2 
1 

18 

8 
8 
1 
1 

16 

12 

4 
6 

1 
1 

35 

17 
10 
1 

7 

42 

18 
21 
1 
2 

30 

White  males  

White  females         

Colored  males  

Colored  females  

Of  the  stomach,  liver  

White  males     

White  females  .... 
Colored  males  

Colored  females  

Of  the  peritoneum,  intes- 
tines, rectum  

White  males            .          

White  females  

Colored  males  

Colored  females  

2 
4 

Of  the  female  genital  organs 
White  males  

5 

3 

White  females  

6499 

4 

5 

3 

14 

25 

Colored  males  

Colored  females  

1383 
3579 

31 
3004 
9 
535 

938 

478 
409 
25 
26 

5279 

2563 
2209 
240 
267 

1 

2 
1 

5 

4 

Of  the  breast  

White  males  

White  females  

1 

1 

3 

Colored  males  

Colored  females  

1 
4 

3 
1 

Of  the  skin  

3 
3 

5 

2 
3 

5 

1 
4 

2 

1 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Of  other  organs  or  of 
organs  not  specified  .  .  . 

White  males  

114 

51 
58 
4 
1 

72 

31 
37 
2 
2 

57 

31 

24 

2 

112 

58 
45 
3 
6 

97 

57 
31 

1 
8 

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


317 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

i 

Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

4 

11 

30 

72 

117 

168 

218 

222 

229 

152 

99 

39 

2 

5 

20 

44 

86 

120 

157 

173 

180 

114 

74 

1 

4 

5 

18 

15 

25 

40 

29 

39 

30 

22 

1 

2 

6 

15 

12 

14 

11 

6 

3 

2 

1 

1 

3 

4 

1 

11 

7 

9 

4 

5 

1 

71 

186 

417 

745 

1184 

1907 

2436 

2716 

2183 

1522 

697 

40 

30 

56 

123 

236 

436 

715 

933 

1085 

837 

580 

239 

26 

84 

217 

416 

613 

1021 

1301 

1427 

1241 

868 

422 

7 

13 

29 

40 

53 

82 

84 

96 

45 

30 

12 

8 

33 

48 

53 

82 

89 

118 

108 

60 

44 

24 

73 

110 

213 

276 

393 

624 

643 

700 

653 

462 

228 

41 

22 

26 

52 

68 

119 

176 

210 

245 

217 

160 

61 

35 

57 

116 

161 

238 

385 

394 

424 

410 

284 

156 

6 

6 

10 

10 

7 

16 

12 

10 

10 

7 

7 

11 

21 

35 

37 

29 

47 

27 

21 

16 

11 

4 

143 

325 

727 

1022 

1212 

1277 

1169 

903 

598 

320 

128 

42 

95 

229 

547 

816 

992 

1078 

988 

785 

523 

283 

112 

48 

96 

180 

206 

220 

199 

181 

118 

75 

37 

16 

25 

108 

256 

412 

506 

553 

500 

416 

396 

256 

145 

43 

1 

3 

2 

2 

7 

9 

5 

2 

'is 

86 

202 

346 

421 

470 

429 

342 

332 

223 

130 

2 

1 

2 

1 

2 

1 

5 

22 

52 

64 

81 

79 

69 

67 

54 

28 

13 

7 

9 

21 

27 

41 

67 

99 

154 

172 

180 

142 

44 

1 

5 

11 

15 

22 

39 

52 

83 

94 

80 

66 

5 

3 

6 

8 

14 

20 

39 

59 

74 

97 

75 

1 

1 

4 

3 

3 

4 

5 

1 

2 

1 

1 

3 

2 

5 

4 

7 

3 

1 

99 

161 

227 

312 

472 

609 

718 

802 

670 

492 

265 

46 

48 

64 

77 

115 

185 

294 

357 

414 

360 

283 

138 

39 

74 

112 

150 

221 

248 

297 

303 

263 

192 

115 

4 

7 

21 

24 

26 

40 

32 

37 

25 

8 

6 

8 

16 

17 

23 

40 

27 

32 

48 

22 

9 

6 

318 


MORTALITY   STATISTICS  OF   INSURED   WAGE   EARNERS. 


NUMBER  or   DEATHS   FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  IN( 
Number. 

Cause  of  Heath. 

Age  Period*. 

AU 
a*w-l 

yr.  and 
over. 

1U>4. 

fitoO. 

10  to 
14. 

16  to 
10. 

20  to 
24. 

46 

47 
48 
49 
50 
51 
52 

Other  tumors  (tumors  of  the 
female  genital  organs 
excepted)  .                    

293 

51 
161 
9 
72 

3409 

1303 
1511 
245 
350 

598 

159 
336 
41 
62 

21 

11 
8 

1 
1 

7762 

2305 
4754 
289 
414 

743 

40 
592 
8 
103 

164 

56 
103 
2 
3 

7 

4 
3 

3 

1 
2 

2 

1 

1 
1 

5 
1 

2 

White  males  

White  females             

Colored  males 

Colored  females  

126 

70 
48 
6 
2 

1 
1 

670 

266 
269 
17 
18 

3 

2 
1 

1 
497 

202 
256 
16 
23 

4 
4 

322 

150 
133 
15 
24 

9 

3 
5 

1 

2 
209 

74 
98 
17 
20 

10 

5 
2 
2 
1 

1 

Acute  articular  rheumatism.  .  .  . 
White  males  

White  females  

Colored  males  

Colored  females  

Chronic  rheumatism  and  gout.  . 
White  males  

White  females  

Colored  males  

Colored  females      .  .         .... 

Scurvy  

11 

7 
4 

1 

1 

1 

1 

White  males  

White  females  .        

1 

1 

Colored  males  .        

Colored  females      

1 
218 

109 
96 
10 
3 

66 

8 
51 

Diabetes  

83 

41 
39 

3 

122 

53 
60 
7 
2 

1 
1 

224 

94 
121 
1 

8 

6 

1 
5 

242 

120 
109 
8 
5 

46 

7 
35 

White  males  

White  females  

Colored  males         

Colored  females  

Exophthalmic  goiter  

White  males  

White  females  

Colored  males  

Colored  females  

1 

2 

1 
1 

4 
8 

4 
3 

7 
14 

9 
5 

Addison's  disease  

White  males  

White  females  

1 

Colored  males  

Colored  females  

1 

APPENDIX   A. 


319 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AOE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age 

Period 

a. 

Int'I  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

14 

16 

27 

44 

28 

18 

27 

32 

32 

30 

7 

46 

3 

2 

1 

2 

4 

2 

4 

8 

7 

9 

1 

9 

6 

13 

15 

17 

13 

17 

17 

23 

18 

6 

1 

1 

3 

3 

1 

1 

7 

13 

24 

4 

3 

5 

7 

2 

3 

166 

166 

147 

183 

170 

176 

192 

160 

168 

100 

57 

47 

53 

51 

48 

58 

57 

72 

60 

46 

48 

30 

18 

75 

70 

54 

66 

64 

59 

85 

81 

82 

49 

22 

13 

15 

24 

24 

18 

24 

17 

12 

13 

5 

9 

25 

30 

21 

35 

31 

21 

30 

21 

25 

16 

8 

16 

21 

15 

17 

44 

41 

64 

81 

108 

101 

63 

48 

7 

8 

4 

6 

10 

8 

18 

19 

26 

28 

11 

5 

9 

5 

9 

23 

28 

31 

43 

64 

64 

46 

1 

2 

2 

1 

4 

2 

6 

9 

4 

3 

4 

3 

2 

4 

1 

7 

3 

9 

10 

14 

6 

2 

1 

2 

1 

1 

1 

49 

1 

1 

1 

1 

1 

1 

215 

239 

250 

333 

541 

859 

1191 

1257 

1066 

641 

281 

50 

95 

95 

90 

120 

150 

229 

291 

300 

261 

185 

72 

94 

106 

120 

158 

304 

525 

787 

867 

753 

426 

189 

11 

18 

22 

26 

34 

30 

49 

32 

18 

15 

8 

15 

20 

18 

29 

53 

75 

64 

58 

34 

15 

12 

68 

90 

86 

100 

80 

62 

49 

51 

27 

8 

3 

51 

4 

3 

2 

3 

5 

2 

3 

1 

54 

70 

74 

80 

62 

48 

38 

41 

25 

6 

3 

.  .  . 

2 

1 

2 

3 

10 

15 

10 

16 

11 

12 

8 

7 

1 

2 

14 

14 

16 

14 

22 

16 

12 

11 

16 

3 

1 

52 

4 

4 

6 

5 

4 

1 

5 

5 

6 

2 

10 

10 

9 

9 

16 

14 

7 

6 

10 

1 

i 

1 

1 

1 

1 

320 


MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


NUMBER  OF  DEATHS   FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


j 

igp  ivrl 

oa* 

Infl  Ltet 
Number. 

C»UM  of  Death. 

All 
•get—  I 
yr.  and 
over. 

1  to  4. 

6  to  9. 

10  to 
14. 

15  to 
19. 

20  to 
24. 

53 

Leukemia  

762 

70 

88 

62 

68 

67 

White  males  

378 

44 

57 

30 

34 

36 

White  females  

309 

22 

27 

19 

14 

23 

Colored  males  

39 

1 

1 

3 

6 

4 

Colored  females  

36 

3 

3 

6 

4 

64 

Anemia,  chlorosis  

1772 

63 

44 

63 

90 

66 

White  males  

507 

29 

27 

13 

30 

9 

White  females     

1103 

29 

14 

25 

48 

44 

Colored  males  

49 

5 

1 

2 

3 

Colored  females  

113 

3 

14 

10 

9 

65 

Other  general  diseases  

426 

112 

38 

22 

36 

24 

White  males  

160 

58 

17 

11 

14 

8 

White  females  

213 

51 

19 

10 

15 

12 

Colored  males 

18 

2 

3 

2 

Colored  females  

35 

1 

2 

1 

3 

2 

56 

Alcoholism  (acute  or  chronic)  .  . 
White  males  

2555 
1889 

3 
1 

1 

2 
2 

8 
2 

54 
37 

White  females  

405 

1 

1 

8 

Colored  males  

207 

1 

2 

5 

Colored  females  

54 

1 

3 

4 

67 

Chronic  lead  poisoning  

191 

1 

2 

3 

White  males  

168 

1 

2 

3 

White  females  

5 

Colored  males  

18 

Colored  females  

58 

Other  chronic  occupation 
poisonings  

9 

1 

White  males  

6 

White  females  

1 

1 

Colored  males  

2 

Colored  females  

69 

Other  chronic  poisonings  

164 

6 

17 

White  males  

69 

5 

11 

White  females  

71 

3 

Colored  males  

8 

1 

Colored  females  

16 

3 

APPENDIX   A. 


321 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 

26  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

69. 

64, 

69. 

74. 

over. 

49 

34 

53 

52 

41 

57 

51 

40 

32 

14 

4 

63 

25 

14 

15 

23 

12 

20 

26 

23 

11 

8 

18 

14 

34 

21 

24   32 

22 

14 

18    5 

2 

3 

3 

2 

6 

2    2 

2 

1 

1    1 

2 

3 

3 

2 

2 

3    3 

1 

2 

2 

70 

78 

105 

123 

151 

193 

232 

193 

162   97 

53 

54 

14 

16 

31 

16 

49 

50 

66 

61 

49   28 

19 

46 

54 

58   94 

91!  124 

157 

126 

98   63 

32 

2 

2 

4    5 

1!    7 

5 

4 

4    3 

1 

8 

6 

12 

8 

10   12 

4 

2 

11 

3 

1 

22 

17 

16 

22 

22    22 

19 

12 

19 

16 

8 

55 

5 

5 

5 

6 

6    2 

5 

4 

7 

5 

2 

13 

9 

7 

11 

14!   12 

12 

4 

8 

11 

6 

2 

1 

2 

1 

I1    1 

1 

1 

1 

2 

2 

2 

4 

1    7 

2 

3 

3 

208 

315 

454 

435 

345 

295 

198 

114 

82 

31 

10 

56 

150 

227 

323 

317 

255 

229 

167 

84 

65 

21 

9 

36 

61 

70 

77 

59   40 

17 

18 

10 

7 

16 

21 

50 

33 

27 

18 

12 

11 

7 

3 

1 

6 

6 

11 

8 

4 

8 

2 

1 

10 

18 

21 

31 

26 

23 

22 

15 

13 

4 

2 

57 

7 

12 

19 

27 

20 

23 

22 

14 

12 

4 

2 

1 

2 

1 

1 

2 

4 

1 

3 

6 

1 

1 

58 

1 

1 

3 

1 

2 

1 

1 

2 

1 

1 

1 

1 

59 

19 

23 

14 

15 

14 

15 

14 

6 

11 

6 

4 

9 

6 

6 

5 

4 

7 

6 

2 

4 

2 

2 

4 

13 

5 

7 

9 

7 

6 

4 

7 

4 

2 

3 

1 

1 

1 

1 

3 

4 

2 

2 

1 

1 

322          MORTALITY   STATISTICS  OF   INSURED  WAGE   EARNERS. 

NuMBEa  or  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


I  nfl  l.i.-t 

Number. 

Cause  of  Death. 

Age  Period*. 

All 
ages  —  1 
yr.  aad 
over. 

\  to  4. 

5  toO. 

10  to 
14. 

15  to 
10. 

20  to 
24. 

60  to  76 
60 
61 
*A61 
62 
63 

A63 

II.  DISEASES  OF  THE  NER- 
VOUS SYSTEM  AND  or  THE 
ORGANS  or  SPECIAL 
SENSE  

57606 

21801 
26150 
4184 
5471 

3961 

1950 
1645 
195 
171 

1865 

899 
766 
114 
86 

989 

435 
409 
79 
66 

1034 

480 
373 
104 
77 

919 

392 
326 
100 
101 

White  males  

White  females  

Colored  males   

Colored  females  

Encephalitis             

519 

214 
200 
53 
52 

4171 

1907 
1663 
336 
265 

823 

378 
275 
97 
73 

797 

513 
191 
59 
34 

4049 

1846 
1716 
239 
248 

1889 

990 
768 
69 
62 

83 

37 
36 
4 
6 

1705 

834 
716 
82 
73 

279 

146 
112 
12 
9 

61 

27 
21 
7 
6 

799 

370 
327 
58 
44 

160 

70 
58 
19 
13 

2 
2 

38 

11 
18 
6 
3 

404 

164 
172 
35 
33 

101 

42 
33 
13 
13 

5 

4 
1 

40 

17 
20 
2 
1 

327 

165 
101 
40 
21 

90 

55 
17 
13 
6 

1 
I 

37 

20 
10 
2 
5 

182 

71 
59 
30 
22 

50 

18 
17 
9 
6 

3 

1 
1 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Meningitis  (total)  

White  males  

White  females  

Colored  males  

Colored  females  

Cerebrospinal  fever  

White  males  

White  females  

Colored  males  

Colored  females  

Locomotor  atazia  

White  males  

White  females  

Colored  males  

Colored  females  

Other  diseases  of  the  spinal 
cord  (total)  

1149 

602 
473 
42 
32 

1095 

674 
453 
40 
28 

555 

286 
228 
19 
22 

510 

265 
209 
16 
20 

133 

71 
53 

4 
5 

102 

53 
45 
1 
3 

106 

58 
34 
5 
9 

55 

34 
17 
2 
2 

83 

35 
36 
8 
4 

27 

11 
13 
3 

Whitfl  Rifl-l"**.  ,,.......  

White  females  

Colored  males  

Colored  females  

Acute  anterior  poliomyelitis 
White  males  

White  females  

Colored  males  

Colored  females  

*  Includes  only  deaths  reported  as  due  to  cerebrospinal  fever  during  the 


APPENDIX   A. 


323 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 

Age  Periods. 


Infl  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

64. 

69. 

04. 

69. 

74. 

over. 

1013 

1400 

1831 

2569 

3522 

5090 

6173 

7716 

8052 

6895 

4577 

60  to  76 

392 

554 

653 

898 

1149 

1701 

2215 

2821 

2955 

2614 

1693 

395 

490 

676 

996 

1515 

2168 

2757 

3612 

3991 

3537 

2494 

118 

181 

236 

302 

361 

513 

488 

515 

437 

286 

155 

108 

175 

266 

373 

497 

708 

713 

768 

669 

458 

235 

40 

26 

22 

31 

27 

31 

29 

19 

17 

9 

9 

60 

19 

12 

5 

17 

6 

15 

8 

5 

6 

4 

5 

13 

^ 

9 

9 

14 

12 

13 

10 

6 

4 

3 

4 

7 

1 

1 

4 

2 

6 

3 

3 

1 

4 

5 

7 

4 

3 

2 

2 

1 

2 

i 

135 

126 

90 

100 

85 

75 

44 

52 

25 

14 

8 

61 

59 

40 

34 

41 

36 

31 

21 

23 

7 

8 

3 

50 

52 

28 

41 

30 

28 

16 

20 

16 

4 

3 

18 

17 

15 

14 

9 

8 

3 

4 

1 

1 

1 

8 

17 

13 

4 

10 

8 

4 

5 

1 

1 

1 

33 

26 

19 

19 

17 

15 

3 

6 

4 

1 

61 

12 

7 

7 

5 

6 

5 

1 

3 

1 

12 

5 

4 

7 

4 

1 

1 

4 

5 

Q 

2 

5 

3 

6 

1 

4 

5 

6 

2 

4 

3 

1 

2 

9 

23 

47 

86 

90 

126 

149 

116 

68 

46 

26 

62 

4 

13 

25 

55 

58 

84 

94 

79 

42 

32 

20 

3 

7 

15 

20 

18 

27 

38 

25 

19 

13 

4 

1 

1 

3 

8 

8 

10 

10 

7 

6 

1 

2 

1 

2 

4 

3 

6 

5 

7 

5 

1 

64 

90 

87 

122 

143 

248 

234 

320 

339 

244 

132 

63 

25 

36 

37 

37 

53 

83 

85 

129 

148 

107 

54 

28 

36 

38 

52 

61 

106 

110 

148 

146 

105 

62 

5 

11 

8 

18 

11 

26 

21 

14 

26 

15 

6 

6 

7 

4 

15 

18 

33 

18 

29 

19 

17 

10 

9 

16 

4 

7 

7 

7 

12 

11 

17 

5 

5 

A63 

5 

8 

3 

5 

1 

6 

7 

3 

11 

3 

1 

3 

4 

1 

2 

1 

4 

5 

6 

1 

4 

1 

1 

4 

1 

3 

2 

3 

1 

period  1912  to  1916;  such  deaths  were  not  tabulated  separately  in  1911. 


324 


MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


NUMBER  or  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


1  llfl  1  l-t 
Number. 

CMiae  of  EX*tb. 

Age  Periods. 

All 
ages—  1 
yr.  and 
over. 

i  i.i  i. 

5U>9. 

10  to 
14. 

IS  to 
10. 

20  to 
24. 

64 
65 
66 

67 
68 

69 
70 

Cerebral  hemorrhage,  apoplexy 
While  males                     

36638 

12886 
17855 
2347 
3550 

488 

193 
215 
38 
42 

2773 

758 
1066 
358 
591 

2224 

1056 
691 
274 
203 

757 

195 
389 
82 
91 

1869 

864 
689 
181 
135 

98 

28 
49 
6 
15 

138 

54 

60 
12 
12 

1 
1 

54 

23 
20 
9 
2 

3 
2 

51 

S 

5 
7 

o 

1 

19 

5 
8 
4 
2 

2 
2 

96 

31 
39 
9 
17 

8 

4 
2 

1 
1 

18 

7 
6 
2 
3 

7 

4 
2 

1 

160 

55 
59 

18 
2S 

5 

1 
3 

1 

12 

1 
2 
6 
3 

4 

2 
1 

1 

White  females  

Colored  males  

Colored  females  

Softening  of  the  brain  

White  males  

White  females  

Colored  males  

19 

11 

7 
1 

1 

17 

9 
5 

Colored  females  

Paralysis  without  specified 
cause  

White  males  

White  females  

Colored  males  

Colored  females  

General  paralysis  of  the  insane  . 
White  males  

1 

1 

White  females  

Colored  males  

Colored  females  ,  .  .  .  . 

Other  forms  of  mental 
alienation  

2 
2 

; 

26 
26 
4 
3 

76 

38 
33 
2 
3 

30 

14 
13 
1 
2 

116 

59 
40 
12 
5 

11 

7 
1 
1 
2 

28 

6 
14 
4 

4 

215 

99 
75 
28 
13 

9 

7 
1 

1 

51 

16 
21 

7 
7 

220 

108 
72 
20 
20 

8 

1 

7 

White  males  

White  females  

Colored  males  

Colored  females  

Epilepsy  

White  males  

White  females  

Colored  males  

Colored  females  

Convulsions  (nonpuerperal)  .  .  . 
White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


325 


CONDITION.     CLASSIFIED  BY  COLOR.,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

esto 
69. 

70  to 

74. 

75  and 
over. 

248 

506 

861 

1378 

2308 

3698 

4805 

6172 

6575 

5753 

3835 

64 

80 

176 

263 

410 

668 

1173 

1688 

2252 

2410 

2160 

1418 

80 

185 

334 

555 

1067 

1676 

2245 

2988 

3363 

3049 

2121 

47 

69 

109 

165 

230 

340 

332 

373 

306 

206 

117 

41 

76 

155 

248 

343 

509 

540 

559 

496 

338 

179 

6 

6 

10 

17 

23 

30 

35 

71 

101 

100 

68 

65 

4 

5 

8 

8 

7 

12 

24 

34 

48 

32 

5 

1 

2 

7 

12 

14 

17 

33 

45 

41 

32 

1 

2 

2 

5 

2 

9 

9 

4 

2 

1 

1 

3 

4 

4 

5 

13 

7 

2 

25 

54 

56 

104 

172 

260 

325 

441 

525 

426 

300 

66 

5 

19 

16 

26 

27 

43 

90 

112 

160 

137 

90 

7 

16 

11 

26   68 

72 

101 

172 

221!  186 

158 

5 

11 

15 

23 

18 

58 

50 

54 

50!   39 

19 

8 

8 

14 

29 

59 

87 

84 

103 

94 

64 

33 

37 

133 

249 

300 

311 

277 

234 

218 

185 

163 

103 

67 

14 

69 

133 

152 

164 

144 

103 

95   69   63 

43 

12 

33 

52 

78 

78 

73 

76 

79   79 

73 

53 

1 

20 

47 

37 

49 

31 

34 

20    19 

10 

4 

10 

11 

17 

33 

20 

29 

21 

24 

18 

17 

3 

62 

75 

68 

86 

74 

78 

63 

74 

48 

31 

17 

68 

17 

21 

18 

15 

21 

19 

11 

21 

19 

8 

3 

32 

31 

32 

54 

34 

43 

37 

36    22 

19 

12 

6 

8 

9 

7 

8 

10 

8 

9    3 

3 

7 

15 

9 

10 

11 

6 

7 

8 

4 

1 

2 

229 

188 

162 

159 

104 

71 

90 

69 

51 

35 

25 

69 

104 

96 

55 

75 

48 

34 

35 

24   31 

20 

12 

92 

58 

75 

57 

39 

24 

36 

29    14 

8 

11 

20 

27    14 

12 

9 

9 

8 

11 

2 

£ 

1 

13 

7 

18 

15 

8 

4 

11 

5 

4 

5 

1 

10 

10 

3 

3 

5 

1 

2 

2 

1 

3 

70 

1 

1 

2 

1 

1 

7 

4 

1 

3 

3 

1 

1 

1 

1 

1 

1 

2 

4 

1 

1 

1 

1 

326         MORTALITY    STATISTICS  OP   INSURED   WAGE  EARNERS. 


NUMBER  or  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Age  Pi 

TiOdl. 

Infl  I.IHI 
Number. 

C»UM  of  Death. 

All 
ages  —  1 
yr.  and 
over. 

lto4. 

5to9. 

10  to 
14. 

18  to 
10. 

20  to 
24. 

71 

Convulsions  of  infants  

461 

458 

3 

White  males  

204 

204 

White  females     

186 

184 

2 

Colored  males                    .... 

34 

34 

Colored  females  

37 

36 

1 

72 

Chorea  

98 

6 

11 

21 

18 

9 

White  males  

26 

4 

4 

5 

2 

2 

White  females  

65 

1 

7 

16 

14 

7 

Colored  males  

3 

1 

1 

Colored  females  

4 

1 

73 

Neuralgia  and  neuritis  

310 

2 

1 

3 

2 

9 

White  males  

102 

1 

2 

1 

White  females  

164 

1 

1 

1 

1 

5 

Colored  males  

15 

1 

1 

Colored  females  

29 

2 

74 

Other  diseases  of  the  nervous 
system  

1349 

88 

92 

73 

67 

78 

White  males  

632 

50 

46 

39 

33 

38 

White  females  

592 

32 

37 

25 

25 

29 

Colored  males  

108 

6 

7 

6 

5 

4 

Colored  females  

117 

2 

3 

4 

7 

75 

Diseases  of  the  eyes  and  their 
annexa  

43 

14 

6 

1 

3 

White  males  

16 

8 

3 

1 

1 

White  females  

18 

6 

2 

2 

Colored  males  

2 

Colored  females  

7 

1 

76 

Diseases  of  the  ears  

962 

237 

154 

108 

89 

58 

White  males  

461 

118 

74 

39 

63 

40 

White  females  

401 

101 

70 

67 

31 

14 

Colored  males  

49 

9 

7 

6 

3 

2 

Colored  females  

51 

9 

3 

6 

2 

2 

77  to  85 

III.  DISEASES  OF  THE 
CIBCUUATOBY  SYSTEM  . 

White  males  

94415 
34636 

563 

265 

1583 
657 

2096 
808 

2201 
923 

2060 
757 

White  females  

43556 

229 

810 

1098 

1011 

964 

Colored  males  

7257 

35 

49 

81 

115 

125 

Colored  females  

8966 

34 

67 

109 

152 

214 

APPENDIX   A. 


327 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

64. 

69. 

04. 

69. 

74. 

over. 

71 
72 

7 

1 

2 

1 

2 

3 

7 

1 

6 

3 

2 

1 

3 

3 

fi 

1 

1 

4 

1 

5 

3 

1 

2 

1 

23 

32 

36 

29 

31 

33 

34 

26 

21 

12 

16 

73 

8 

12 

11 

10 

9 

10 

13 

7 

8 

5 

5 

13 

15 

19 

17 

19 

18 

16 

12 

9 

7 

10 

2 

1 

2 

4 

3 

... 

1 

2 

5 

4 

2 

2 

3 

1 

4 

4 

71 

95 

111 

122 

115 

107 

90 

101 

71 

44 

24 

74 

29 

33 

38 

40 

32 

41 

40 

39 

12 

16 

6 

32 

39 

50 

62 

63 

51 

35 

39 

38 

19 

16 

6 

6 

8 

13 

10 

7 

7 

8 

11 

0 

1 

4 

17 

15 

7 

10 

8 

8 

15 

10 

6 

1 

1 

1 

1 

2 

6 

4 

2 

2 

75 

1 

1 

1 

1 

4 

2 

1 

1 

1 

1 

1 

1 

1 

1 

I 

47 

35 

27 

31 

32 

52 

34 

22 

20 

10 

6 

76 

26 

21 

12 

11 

17 

17 

11 

7 

8 

6 

1 

16 

11 

9 

15 

8 

23 

16 

12 

10 

4 

4 

4 

2 

2 

2 

3 

5 

3 

1 

1 

1 

4 

3 

4 

7 

4 

3 

2 

2457 

3170 

4260 

5129 

6331 

8134 

9782 

12811 

13687 

12132 

8019 

77  to  85 

835 

1047 

1316 

1654 

2188 

2791 

3628 

4811 

6264 

4687 

3005 

1072 

1212 

1597 

1944 

2459 

3431 

4294 

5995 

6793 

6255 

4392 

257 

440 

616 

707 

737 

853 

850 

897 

709 

638 

248 

293 

471 

731 

824 

947 

1059 

1010 

1108 

921 

652 

374 

328 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  OF   DEATHS  FROM   EACH  SPECIFIED  DISBASB  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Age  P 

BrUxta. 

Infl  I.Ut 
Number. 

Cause  of  Death. 

All 
agea  —  1 
yr.  and 
over. 

1  U>4 

5  to  9. 

10  to 
14. 

15  to 
10. 

20  to 
34. 

77 

Pericarditis  

624 

11 

42 

31 

23 

25 

White  males  

197 

2 

15 

10 

12 

9 

White  females  

252 

7 

22 

17 

7 

9 

Colored  males  

73 

2 

2 

2 

3 

Colored  females  

102 

3 

2 

1 

7 

78 

Acute  endocarditis  

5080 

150 

302 

271 

280 

268 

White  males  

1871 

75 

110 

98 

110 

96 

White  females  

2269 

63 

169 

149 

133 

124 

Colored  males  

412 

6 

10 

13 

19 

Colored  females  

528 

6 

15 

14 

24 

29 

79 

Organic  diseases  of  the  heart  .  .  . 
White  males  

75345 
26923 

328 
150 

1182 
503 

1754 
683 

1833 

774 

1667 
620 

White  females  

35225 

133 

600 

917 

848 

787 

Colored  males  

5830 

22 

35 

63 

92 

98 

Colored  females  

7367 

23 

44 

91 

119 

162 

80 

Angina  pectoris  

2218 

2 

8 

5 

14 

25 

White  males  

977 

5 

1 

6 

7 

White  females  

889 

2 

2 

3 

4 

12 

Colored  males  

141 

1 

2 

4 

Colored  females  

211 

1 

2 

2 

81 

Diseases  of  the  arteries, 
atheroma,  aneurism,  etc..  .  . 

White  males  

9142 
4020 

1 

4 
3 

12 
6 

15 

7 

White  females  

3894 

1 

3 

2 

Colored  males  

651 

1 

1 

2 

Colored  females  

577 

2 

4 

82 

Embolism  and  thrombosis  
White  males  

1192 
380 

10 
6 

12 
5 

9 
4 

17 
6 

34 
8 

White  females  

628 

3 

7 

4 

9 

22 

Colored  males  

84 

1 

1 

Colored  females  

100 

1 

1 

4 

83 

Diseases  of  the  veins  (varices, 
hemorrhoids,  phlebitis,  etc.) 

White  males  

455 
118 

2 

4 
3 

1 
1 

5 
2 

9 
2 

White  females  

267 

1 

1 

2 

4 

Colored  males  

24 

1 

1 

Colored  females  

46 

1 

2 

APPENDIX   A. 


329 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 
Number. 

25  to 
20. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 

49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

37 

36 

42 

35 

45 

49 

63 

62 

47 

53 

23 

77 

8 

10 

10 

15 

13 

20 

18 

20 

18 

14 

2 

18 

6 

9 

8 

18 

15 

22 

27   20 

30 

17 

6 

10 

11 

4 

6 

5 

9 

6 

4 

3 

5 

10 

12 

8 

8 

9 

14 

9 

5 

6 

3 

293 

352 

443 

431 

580 

645 

714 

178 

81 

67 

25 

78 

90 

137 

139 

143 

230 

244 

282 

65 

24 

19 

9 

135 

138 

185 

173 

215 

278 

322 

89 

43 

38 

15 

29 

28 

65 

55 

58 

51 

51 

10 

4 

4 

1 

39 

49 

54 

60 

77 

72 

59 

14 

10 

6 

1970 

2561 

3403 

4202 

5089 

6571 

7790 

10702 

11055 

9390 

5848 

79 

696 

824 

1035 

1354 

1711 

2161 

2794 

3898 

4083 

3499 

2138 

860 

1008 

1309 

1602 

2018 

2838 

3450 

5085 

5622 

4919 

3229 

191 

359 

447 

559 

578 

699 

705 

770 

588 

431 

193 

223 

370 

612 

687 

782 

873 

841 

949 

762 

541 

288 

39 

65 

95 

120 

166 

216 

286 

368 

386 

277 

146 

80 

7 

27 

37 

33 

72 

107 

145 

157 

189 

132 

52 

19 

16 

26 

42 

45 

67 

110 

162 

163 

128 

88 

7 

5 

18 

20 

16 

15 

16 

19 

12 

6 

6 

17 

14 

25 

33 

27 

15 

30 

22 

11 

6 

45 

88 

170 

195 

271 

463 

751 

1267 

1873 

2136 

1851 

81 

15 

26 

60 

72 

115 

199 

332 

584 

882 

951 

768 

10 

14 

18 

36 

68 

141 

295 

520 

803 

1022 

961 

14 

30 

67 

62 

58 

61 

57 

76 

88 

84 

50 

6 

18 

25 

25 

30 

62 

67 

87 

100 

79 

72 

41 

38 

52 

83 

113 

118 

110 

143 

168 

154 

90 

82 

10 

13 

21 

19 

32 

35 

40 

57 

46 

50 

28 

19 

15 

25 

49 

55 

58 

55 

66 

94 

91 

56 

3 

4 

3 

2 

16 

14 

7 

9 

12 

9 

3 

9 

6 

3 

13 

10 

11 

8 

11 

16 

4 

3 

14 

18 

42 

40 

50 

50 

49 

66 

53 

29 

23 

83 

4 

5 

9 

7 

10 

18 

13 

19 

14 

7 

4 

7 

11 

21 

27 

33 

27 

31 

33 

33 

19 

17 

2 

1 

2 

1 

3 

3 

2 

6 

1 

1 

1 

1 

10 

5 

4 

2 

3 

8 

5 

3 

1 

330 


MORTALITY    STATISTICS  OF   INSURED  WAGE   EARNERS. 


NUMBER  01    DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Int'l  i.ii  t 
Number. 

C'BUM  of  Death. 

Ace  Period*. 

All 
age*  —  1 
yr.and 
over. 

l  to  4. 

5  toO. 

10  to 
14. 

16  to 
19. 

20  to 
24. 

84 
85 
86  to  98 

86 

87 
88 
89 

Diseases  of  the  lymphatic  sys- 
tem (lymphangitis,  etc.)  .  .  . 

White  males            

165 

83 
56 
15 
11 

194 

67 
76 
27 
24 

71345 

29140 
29443 
6642 
6120 

57 

32 
17 
5 
3 

3 
3 

13887 

6208 
5611 
1026 
1042 

27 

14 
7 
2 
4 

5 

2 
1 
1 
1 

2888 

1218 
1195 
206 
269 

14 

0 
6 
3 

7 

2 
3 
1 
1 

1168 

435 
478 
121 
134 

6 

2 
2 
1 
1 

11 

6 
3 
1 
2 

1786 

697 
563 
248 
278 

8 

3 
3 

1 
1 

9 

5 

1 

3 

2200 

812 
666 
377 
345 

White  females       

Colored  males             

Colored  females             

Hemorrhage;  other  diseases  of 
the  circulatory  system  .  .  ,  ,  - 

White  males          

Colored  males  

Colored  females  

IV.  DISEASES  or  THE  RE- 
SPIRATORY SYSTEM  .... 

White  males  

White  females  

Colored  males  

Colored  females  

Diseases  of  the  nasal  fossae  .  .  . 
White  males  

72 

33 
26 
9 
4 

594 

305 
227 
34 
28 

188 

26 
130 
5 
27 

2636 

943 
1224 
196 
273 

12 

7 
2 
3 

6 

5 
1 

7 

4 
3 

5 

3 
2 

2 

i 

1 

White  females  

Colored  males  

Colored  females  

Diseases  of  the  larynx  

300 

167 
111 
9 
13 

4 

2 
2 

1218 

500 
494 
98 
126 

119 

64 
51 
4 

24 

12 
10 
2 

7 

3 
2 
1 
1 

15 

5 
5 

1 
4 

37 

8 
12 
3 
14 

8 

3 
2 
2 
1 

16 

3 
12 

1 

35 

9 
10 

8 
8 

White  males  

White  females  

Colored  males  

Colored  females  

Diseases  of  the  thyroid  body.  .  . 
White  males  

5 

2 
3 

143 

64 
57 
6 
16 

13 

5 

7 

1 
35 

14 
6 
7 
8 

White  females  

Colored  males  

Colored  females  

Acute  bronchitis  

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX  A. 


331 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

7 

4 

5 

6 

2 

4 

6 

6 

5 

6 

2 

84 

4 

1 

3 

5 

2 

1 

5 

3 

2 

1 

2 

2 

1 

2 

1 

4 

1 

2 

4 

2 

1 

1 

1 

1 

1 

11 

8 

8 

17 

15 

18 

13 

19 

19 

20 

11 

85 

1 

4 

2 

6 

6 

5 

3 

6 

5 

13 

3 

3 

2 

2 

6 

6 

6 

5 

12 

13 

4 

7 

4 

2 

3 

4 

2 

4 

3 

1 

1 

3 

1 

1 

3 

3 

2 

1 

2 

1 

2572 

3048 

3484 

3876 

4111 

4883 

5550 

6285 

6358 

5524 

3725 

86  to  98 

991 

1297 

1513 

1742 

1879 

2140 

2302 

2468 

2333 

1929 

1176 

781 

855 

989 

1212 

1344 

1814 

2362 

2928 

3334 

3065 

2246 

480 

515 

586 

557 

533 

519 

413 

440 

288 

217 

116 

320 

381 

396 

365 

355 

410 

473 

449 

403 

313 

187 

3 

1 

3 

1 

6 

2 

1 

Q 

7 

7 

86 

3 

1 

2 

3 

3 

2 

1 

2 

1 

i 

4 

3 

5 

2 

1 

1 

1 

1 

1 

2 

16 

17 

14 

14 

13 

10 

11 

7 

19 

9 

6 

87 

3 

4 

8 

6 

6 

2 

6 

6 

9 

5 

1 

4 

11 

4 

3 

2 

3 

5 

1 

10 

4 

4 

5 

2 

2 

3 

2 

2 

4 

2 

3 

3 

1 

10 

12 

13 

12 

15 

15 

21 

12 

13 

8 

4 

88 

1 

1 

1 

2 

1 

2 

1 

9 

7 

10 

11 

8 

11 

16 

9 

9 

7 

4 

2 

1 

2 

2 

1 

5 

3 

4 

1 

3 

1 

42 

39 

49 

44 

49 

59 

103 

146 

197 

231 

209 

89 

10 

10 

15 

11 

24 

21 

30 

54 

59 

66 

48 

10 

7 

14 

13 

11 

29 

62 

79 

124 

149 

147 

13 

8 

9 

10 

10 

3 

6 

5 

3 

2 

5 

9 

14 

11 

10 

4 

6 

5 

8 

11 

14 

9 

332          MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 

NUMBER  OF   DEATHS  FROM    EACH   SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Int'l  Ltot 
Number. 

CMIM  of  Death. 

Age  Period!. 

All 
««e«—  1 

yr.  and 
over. 

I  to  4 

fttoO. 

10  to 
14. 

15  to 
10. 

20tx> 
24. 

90 
91 
92 

93 
94 

95 
96 

Chronic  bronchitis         

4224 

1453 
2070 
286 
415 

16224 

6338 
7505 
1152 
1229 

41707 

17659 
16185 
4318 
3545 

1985 

853 
740 
213 
179 

939 

319 
456 
85 
79 

171 

100 
53 
11 

7 

1594 

607 
583 
182 
222 

75 

29 
24 
10 

12 

7007 

3096 
2896 
514 
501 

4874 

2203 
1930 
375 
366 

246 

145 
86 
12 
3 

95 

35 

48 
4 
8 

3 

1 
2 

63 

22 
25 
6 
10 

972 

387 
426 
77 
82 

1430 

605 
575 
101 
149 

92 

41 
39 

7 
5 

21 

10 
7 
2 
2 

3 

2 

1 

30 

5 
12 

7 
6 

220 

82 
90 
19 
29 

754 

286 
316 
72 
80 

54 

18 
22 
8 
6 

10 

4 
2 
2 
2 

4 

2 
1 
1 

4 

2 
1 

1 

57 

9 
14 
0 
25 

222 

69 
79 
39 
35 

1263 

524 
398 
164 
177 

112 

46 
38 
17 
11 

17 

6 
6 
3 
2 

8 

3 
1 
2 
2 

9 
0 

i 

2 

92 

24 
16 
16 
36 

216 

60 
86 
31 
39 

1608 

630 
463 
286 
229 

128 

53 
41 
20 
14 

21 

7 
6 
3 
5 

11 

3 
6 
2 

13 

2 
5 

1 
5 

White  males             

White  females                 

Colored  males  

Colored  females  

Bronchopneumonia   

White  males  .           

White  females  

Colored  males  

Colored  females  

Pneumonia  —  lobar  and 
undefined  

White  males  

White  females  .        

Colored  males      

Colored  females  

Pleurisy  

White  males  

White  females  

Colored  males  

Colored  females  

Pulmonary  congestion,  pul- 
monary apoplexy  

White  males  

White  females  

Colored  males  

Colored  females  

Gangrene  of  the  lung  

White  males  

White  females  

Colored  males  

Colored  females  

36 

19 

8 

1 
8 

15 

7 
3 
2 
3 

Asthma  

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


333 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

96 

110 

105 

122 

168 

250 

365 

537 

722 

798 

634 

90 

22 

28 

44 

36    64 

97 

135 

200 

253 

267 

218 

25 

24 

26 

45 

58   101 

176   266 

395 

484 

379 

, 

22 

21 

12 

19 

26   29 

21 

26 

29 

22 

11 

27 

37 

23 

22 

20 

23 

33 

45 

45 

25 

26 

258 

282 

313 

384 

456 

614 

803 

1100 

1270 

1218 

889 

91 

91 

107   118 

161 

188 

246 

308 

370 

419 

389 

247 

96 

93   115 

143 

180 

260 

383 

598 

754 

727 

579 

35 

41   48 

44 

43 

53 

47 

68 

33 

35 

25 

36 

41   32 

36 

45 

55 

65 

64 

64 

67 

38 

1922 

2315  2664 

2939 

2992 

3426 

3687 

3894 

3559 

2732 

1648 

92 

788 

1053  1215 

1387 

1418 

1533 

1563 

1575 

1349 

984 

546 

575 

630   713 

883 

971 

1266 

1528 

1766 

1778 

1444 

949 

352 

384   458 

418 

386 

359 

286 

291 

192 

133 

61 

207 

248 

278 

251 

217 

268 

310 

262 

240 

171 

92 

111 

119 

134 

146 

136 

160 

140 

141 

127 

84 

55 

93 

35 

45 

45 

58 

65 

69 

65 

63 

51 

33 

21 

37 

33   51 

52 

43 

63 

56 

51 

61 

42 

25 

21 

24    16 

26 

17 

16 

7 

Q 

8 

3 

2 

18 

17:   22 

10 

11 

12 

12 

18 

7 

6 

7 

25 

36 

40 

48 

41 

43 

83 

88 

112 

139 

120 

94 

5 

9 

16 

21 

10 

17 

34 

26 

38 

47 

34 

10 

15 

9 

16 

19 

11 

33    44 

64   85 

82 

8 

Q 

7 

7 

5 

9 

8 

10 

5    1 

3 

2 

4 

8 

5 

7 

6 

8 

8 

5    6 

1 

7 

13 

13 

13 

20 

19 

20 

15 

8 

12 

2 

95 

2 

8 

5 

9 

14 

14 

12 

9 

5 

10 

1 

3 

5 

7 

4 

5 

3 

6 

5 

3 

1 

1 

1 

1 

1 

1 

1 

1 

1 

1 

2 

29 

52 

67 

76 

123 

166 

186 

236 

243 

223 

116 

96 

12 

7 

18 

20 

41 

72 

67 

95 

104 

94 

41 

3 

18 

28 

28 

30 

42 

72 

83 

105 

95 

62 

8 

14 

9 

13 

19 

28 

22 

24 

16 

17 

7 

6 

13 

12 

15 

33 

24 

25 

34 

18 

17 

6 

334 


MORTALITY    STATISTICS   OF   INSURED    WAGE    EARNERS. 


NUMBER  OF   DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  I.  Lit 
Number. 

Cause  of  De»t  . 

Age  Period*. 

All 
agee—  1 
yr.  and 
over. 

1  to  4. 

5  to  9 

10  to 

14. 

IS  to 
IB. 

30  to 
34. 

97 
98 

99  to  118 
99 

100 
101 
02 

Pulmonary  emphysema  

123 

60 
39 
18 
6 

888 

444 
205 
133 
106 

49146 

19862 
21433 
3526 
4325 

1 
1 

3 

2 

3 
2 

1 

White  males  

Wnite  females                     .... 

Colored  males 

1 

Colored  females  

Other  diseases  of  the  respira- 
tory system  (tuberculosis 
excepted)  

17 

4 

8 

5 

11153 

5356 
4730 
565 
502 

18 

8 
7 

1 
2 

2245 

1029 
944 
131 
141 

13 

1 
8 
3 
1 

1562 

735 
605 
115 
107 

31 

13 
6 
7 
5 

1649 

738 
594 
139 
178 

47 

16 
17 
6 
8 

1676 

649 
659 
138 
230 

White  males  

White  females  

Colored  males  

Colored  females  

V.  DISEASES  OF  THE 
DIGESTIVE  SYSTEM.  .  .  . 

White  males  

White  females  

Colored  males  

Colored  females  

Diseases  of  the  mouth  and 
annexa  

200 

73 
90 
15 
22 

1153 

545 
449 
65 

94 

124 

70 
45 
5 

4 

2159 

929 
806 
189 
235 

45 

28 
15 

1 
1 

277 

149 
105 
9 
14 

16 

8 
8 

22 

10 
12 

293 

144 
124 
10 
15 

5 

4 
1 

7 

3 
3 

i 

116 

45 
54 
7 
10 

3 

4 
3 

i 

82 

43 
34 

1 
4 

10 

5 
3 
1 

1 

70 

32 
20 
6 
12 

2 

1 
1 

White  males  •. 

White  females  

Colored  males  

Colored  females  

Diseases  of  the  pharynx  

White  males  

White  females  

Colored  males  

Colored  females  

Diseases  of  the  esophagus  

White  males  

White  females  

2 

1 

Colored  males  

Colored  females 

Ulcer  of  the  stomach  

16 

7 
7 
1 
1 

16 

6 

7 

14 

6 
5 

51 

18 
25 
3 
5 

108 

39 
47 
7 
15 

White  males  

White  females  

Colored  males  

Colored  females  

3 

3 

APPENDIX   A. 


335 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  Lldt 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

£9. 

64. 

69. 

74. 

0"er. 

4 

3 

6 

7 

5 

10 

16 

21 

16 

16 

12 

97 

1 

2 

2 

7 

9 

10 

7 

9 

8 

1 

2 

1 

1 

2 

6 

7 

8 

7 

3 

3 

1 

4 

3 

2 

1 

1 

t\ 

1 

1 

2 

1 

1 

49 

49 

63 

70 

87 

109 

114 

88 

63 

47 

23 

98 

19 

24 

28 

30 

43 

61 

73 

58 

35 

22 

9 

9 

11 

9 

14 

14 

22 

18 

19    19 

18 

6 

12 

10 

18 

14 

21 

17 

13 

4    2 

3 

2 

9 

4 

8 

12 

9 

9 

10 

7 

7 

4 

6 

1943 

2145 

2644 

2919 

3140 

3626 

3501 

3694 

3225 

2520 

1504 

99  to  118 

670 

699 

886 

1094 

1239 

1468 

1394 

1392 

1127 

871 

515 

782 

836 

1075 

1159 

1300 

1534 

1555 

1742 

1670 

1389 

859 

182 

231 

311 

307 

268 

284 

258 

245 

194 

105 

53 

309 

379 

372 

359 

333 

340 

294 

315 

234 

155 

77 

14 

15 

13 

10 

14 

9 

12 

7 

5 

7 

6 

99 

2 

4 

2 

4 

2 

4 

3 

2 

2 

2 

7 

9 

7 

4 

6 

3 

6 

3 

3 

2 

4 

4 

o 

2 

1 

1 

1 

2 

1 

4 

2 

2 

3 

3 

1 

1 

1 

53 

48 

40 

41 

32 

20 

23 

20 

17 

10 

11 

100 

22 

17 

12 

26 

13 

8 

7 

10 

6 

5 

6 

20 

19 

16 

7 

10 

8 

10 

8 

6 

4 

4 

5 

3 

7 

3 

4 

3 

4 

2 

1 

6 

9 

5 

5 

5 

1 

2 

2 

3 

i 

1 

2 

A 

9 

9 

13 

15 

11 

12 

15 

7 

101 

1    2 

5 

6 

11 

8 

6 

8 

6 

4 

i 

1 

2 

2 

2 

2 

4 

5 

4 

7 

3 

1 

2 

1 

2 

1 

1 

165 

168 

241 

234 

224 

224 

212 

182 

176 

89 

39 

102 

62 

72 

97 

107 

114 

115 

100 

82 

61 

28 

15 

59 

55 

86   70 

70 

74 

79 

72 

85 

46 

19 

17 

17 

28 

31 

21 

13 

14 

13 

14 

7 

3 

27 

24 

30 

26 

19 

22 

19 

15 

16 

8 

2 

336 


MORTALITY   STATISTICS  OF   INSURED  WAGE   EARNERS. 


OF  DEATHS  FROM   EACH  SPECIFIED  DISEASE  01 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  i  .1.-! 
Numbe-. 

CMIM  of  Death. 

Age  Periods. 

All 
«ge»—  1 
yr.aod 
over. 

1  U>4. 

5to9. 

10  to 
14. 

16  to 
10. 

20  to 
24.  . 

103 
104 
105 

106 
107 
108 
A109 

Other  diseases  of  the  stomach 
(cancer  excepted)  

4921 

1480 
1878 
628 
935 

6684 

3199 
2928 
314 
243 

7489 

2830 
3402 
491 
766 

12 

5 

4 
1 

545 

249 
206 
42 
48 

6684 

3199 
2928 
314 
243 

2736 

1284 
1151 
151 
150 

2 

1 
1 

154 

54 

60 
18 
22 

75 

16 

20 
20 
•19 

64 

14 
20 
15 
15 

122 

21 
41 
20 
40 

White  males  .          

White  females  

Colored  males  

Colored  females 

Diarrhea  and  enteritis  (under 
2  vears)  

White  males  

White  females  

Colored  males  

Colored  females  

Diarrhea  and  enteritis  (2  years 
and  over)  

638 

278 
276 
31 
53 

2 

157 

64 

59 
12 

22 

2 

117 

33 
39 
22 
23 

2 
2 

150 

40 
75 
11 
24 

1 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Ankylostomiasis  

White  males  

White  females  

1 

1 

Colored  males  .        

Colored  females  

2 
57 

14 

25 
7 
11 

6345 

2832 
2622 
423 
468 

2357 

788 
1287 
170 
112 

37 

12 
12 
4 
9 

212 

103 
99 
9 
1 

36 

25 
4 
6 
1 

1 

13 
1 

8 
3 

1 

734 

358 
324 
30 
22 

15 
13 
2 

1 
2 

1 
1 

916 

470 
367 
50 
29 

13 

10 
1 
1 

1 

Intestinal  parasites  

... 

1 

White  males  

White  females  

954 

"493 
338 
58 
65 

18 

9 

4 
4 
1 

1 

700 

340 
257 
43 
60 

40 

23 
5 
9 
3 

Colored  males  

Colored  females  

Appendicitis  and  typhlitis  
White  males  

White  females  

Colored  males  

Colored  females  

Hernia  

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


337 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 

49. 

60  to 
64. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

•181 

42 
51 
33 
55 

195 

45 
46 
38 
66 

280 

71 
88 
56 
65 

318 

74 
95 
67 
82 

347 

92 
101 
66 

88 

447 

139 
135 
63 
110 

430 

128 
139 
62 
101 

515 

156 
211 
53 
95 

510 

165 
241 
44 
60 

450 

135 
251 
19 
45 

288 

79 
173 
12 
24 

103 
104 

105 
106 
107 
108 

A109 

185 

70 
69 
16 
30 

1 

i 

200 

59 
80 
20 
41 

245 

82 
90 
26 
47 

2 

1 
1 

237 

77 
90 
28 
42 

219 

63 

90 
22 
44 

284 

88 
124 
23 
49 

355 

122 
149 
39 
45 

508 

145 
267 
33 
73 

526 

138 
303 
29 
56 

552 

160 
331 
17 
44 

380 

127 
219 
11 
23 

1 

1 

1 

1 

1 

1 

1 

1 

581 

242 
246 
40 
53 

37 

15 
10 
9 
3 

470 

157 
201 
43 
69 

67 

25 
22 
14 
6 

384 

133 
157 
40 
54 

98 

32 

47 

Q 

11 

339 

129 
135 
32 
43 

157 

43 
89 
11 
14 

265 

93 
129 
22 
21 

217 

52 
138 
9 
18 

277 

92 
139 
28 

18 

297 

89 
174 
16 
18 

179 

82 
73 
9 
15 

297 

78 
188 
21 
10 

166 

66 
79 
11 
10 

369 

118 
215 
24 
12 

80 

37 
34 
4 
5 

318 

109 
180 
19 
10 

65 

25 
33 
4 
3 

225 

78 
134 
10 
3 

23 

12 
11 

153 

69 
76 
7 
1 

338 


MORTALITY    STATISTICS    OF    INSURED    WAGE    EARNERS. 


NUMBER  OF  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Int'l  Llat 
Number. 

Cau0e  of  Death. 

Age  Periods. 

All 
ages  —  1 

yr.  and 
over. 

1  to  4. 

5  to  9. 

10  to 

14. 

15  to 
10. 

20  to 
24. 

B109 
110 
111 

112 
*113 

114 
115 

Intestinal  obstruction  

3162 

1039 
1580 
209 
334 

1006 

316 
437 
99 
154 

236 

75 
122 
12 
27 

•; 

7 
1 

8064 

4426 
2715 
574 
349 

1591 

217 
1250 
36 
88 

2181 

652 
1122 
195 
212 

313 

180 
111 
9 
13 

54 

30 
16 

4 
4 

5 

2 
3 

152 

75 
54 
14 
9 

29 
11 

li 

6 

4 
2 

86 

49 
24 
9 
4 

20 

13 
5 

1 

1 

8 

4 

4 

122 

55 
39 
14 

14 

39 

18 
16 
2 
3 

4 

1 

1 

133 

50 
61 
6 
16 

43 

14 
20 
5 
4 

30 

7 
18 

White  males  

White  females  

Colored  males     

Colored  females  

Other  diseases  of  the  intestines 
White  males  

White  females  

Colored  males      

Colored  females  

Acute  yellow  atrophy  of  the 
liver  

White  males  

White  females  

Colored  males  

Colored  females  

1 

1 

5 

Hydatid  tumor  of  the  liver  .... 
White  males  

White  females  

| 

Colored  males  

Colored  females.   .  .        

Cirrhosis  of  the  liver  

19 

11 

4 

1 
3 

2 

1 
1 

78 

36 
26 

8 
8 

25 

10 
9 
3 
3 

1 
1 

29 

11 
11 
4 
3 

2 

1 
1 

29 

9 
9 
5 
6 

3 

1 

1 
1 

42 

13 
16 
8 
5 

55 

25 
11 
10 
9 

18 

2 
8 
3 
5 

» 

26 
31 
9 
8 

White  males  

White  females  

Colored  males  

Colored  females  

Biliary  calculi  

White  males  

White  females  

Colored  males  

Colored  females  

Other  diseases  of  the  liver  
White  males  

55 

29 
14 
9 
3 

35 

13 
13 
3 
6 

White  females  

Colored  males  

Colored  females  

*  Includes  alcoholic  cirrhosis  of  the  liver. 


APPENDIX   A. 


339 


CONDITION.    CLASSIFIED  BY  COLOB,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods.           , 

Infl  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

176 
48 

180 
38 

198 
29 

182 
35 

179 

44 

252 
82 

260 

77 

309 
89 

265 
82 

206 
62 

149 
44 

B109 

71 

86 

108 

98 

98 

132 

146 

175 

158 

126 

93 

14 

12 

17 

15 

11 

19 

18 

22 

15 

6 

8 

43 

44 

44 

34 

26 

19 

19 

23 

10 

12 

4 

73 

69 

87 

82 

88 

89 

58 

92 

70 

66 

47 

110 

13 

17 

19 

22 

27 

23 

22 

28 

16 

26 

17 

41 

24 

38 

36 

34 

37 

25 

44 

37 

29 

24 

3 

5 

11 

11 

9 

12 

4 

10 

8 

8 

2 

16 

23 

19 

13 

18 

17 

7 

10 

9 

3 

4 

21 

24 

21 

16 

17 

17 

12 

20 

9 

18 

8 

111 

4 

3 

3 

6 

9 

6 

2 

8 

4 

9 

3 

12 

13 

12 

6 

7 

10 

7 

9 

4 

9 

5 

1 

2 

1 

4 

1 

1 

1 

4 

6 

5 

2 

3 

1 

3 

2 

2 

1 

2 

112 

2 

3 

1 

1 

1 

1 

1 

186 

377 

633 

890 

1072 

1170 

1093 

949 

791 

532 

214 

113 

92 

196 

321 

473 

608 

704 

645 

553 

408 

272 

88 

54 

112 

216 

302 

346 

353 

354 

304 

303 

218 

109 

24 

42 

71 

72 

67 

79   59 

64 

44 

23 

6 

16 

27 

25 

43 

51 

34 

35 

28 

36 

19 

11 

38 

69 

91 

136 

171 

222 

251 

235 

167 

115 

70 

114 

5 

9 

10 

22 

28 

22   32 

30 

23 

17 

16 

26 

48 

65 

103 

133 

181   207 

193 

136 

93;   53 

3 

4 

5 

2 

3 

6    5 

1 

1 

2   ... 

4 

8 

11 

9 

7 

13 

7 

11 

7 

3 

1 

95 

139 

174 

152 

203 

224 

230 

229 

225 

141 

85 

115 

35 

39 

38 

45 

64 

64 

60 

67 

59 

37 

27 

39 

64 

85 

70   95 

119 

132 

131 

141 

91 

55 

8 

19 

26 

19   25 

18 

16 

12 

11 

4 

13 

17 

25 

18 

19 

23 

22 

19 

14 

9 

3 

340 


MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


NUMBER  ui    DEATHS   PROM    EACH   SPECIFIED   DISEASE   OR 
Metropolitan  Life  Insurance  Company  Industrial 


Ag*P« 

r!<x'«. 

InM  Mat 
Number. 

C«UM  of  Death. 

All 

age»—  1 
yr.  and 
over. 

1  to  4. 

5  tog. 

10  to 
14. 

IS  to 

10. 

20  to 
24. 

116 

Diseases  of  the  spleen  

77 

6 

4 

3 

2 

3 

White  males                

39 

4 

2 

1 

2 

2 

WTiitfl  females            .  ,  - 

34 

2 

1 

2 

1 

Colored  males                         .  . 

2 

1 

Colored  females                      •  • 

2 

117 

Simple  peritonitis  (non- 
puerperal)     

1013 

65 

75 

64 

104 

105 

White  males     

210 

27 

28 

23 

23 

17 

\Vhite  females        

490 

29 

36 

28 

45 

54 

Colored  males  

74 

5 

6 

7 

4 

7 

Colored  females  

239 

4 

6 

6 

32 

27 

118 

Other  diseases  of  the  digestive 
system  (cancer  and  tuber- 
culosis exec  pled)  

304 

4 

6 

10 

12 

11 

White  males  

121 

1 

2 

5 

5 

4 

White  females  

140 

1 

4 

4 

4 

5 

Colored  males 

16 

1 

1 

1 

Colored  females  

27 

1 

1 

2 

1 

110  to  133 

VI.    NONVENEREAL  Dl8- 
EA8E8  OF  THE  GENITO- 
URINARY SYSTEM  AND 
ANNEXA  

64919 

618 

593 

484 

933 

1634 

White  males  

24602 

294 

274 

171 

305 

605 

White  females  

28216 

219 

246 

244 

437 

814 

Colored  males  

6335 

60 

37 

35 

52 

90 

Colored  females  

6766 

45 

36 

34 

139 

225 

119 

Acute  nephritis  

5120 

316 

246 

130 

201 

315 

White  males  

1969 

146 

118 

43 

79 

147 

White  females  

1954 

117 

94 

65 

88 

121 

Colored  males  

549 

28 

19 

9 

18 

21 

Colored  females  

648 

25 

15 

13 

16 

26 

120 

PrigVit's  H!sftase,  ,,,...  

52067 

259 

312 

321 

524 

835 

White  males  

20762 

124 

141 

114 

209 

321 

White  females  

22650 

91 

137 

164 

240 

367 

Colored  males  

4234 

29 

15 

24 

31 

63 

Colored  females  

4421 

15 

19 

19 

44 

84 

121 

Chyluria  

3 

1 

White  males  

White  females  

2 

1 

Colored  males  

1 

Colored  females  

APPENDIX   A. 


341 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AQE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Pertoda. 

Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

6 

5 

8 

7 

6 

7 

7 

4 

5 

1 

3 

116 

2 

3 

3 

5 

2 

4 

5 

2 

1 

1 

4 

2 

5 

1 

3 

2 

2 

2 

5 

2 

1 

1 

1 

105 

89 

90 

64 

47 

45 

44 

49 

28 

21 

18 

117 

7 

7 

12 

7 

10 

11 

10 

16 

2 

5 

5 

61 

44 

40 

29 

21 

24   24 

20 

17 

11 

7 

' 

4 

7 

13 

5 

5 

1    2 

2 

2 

2 

3 

33 

31 

25 

23 

11 

9 

8 

11 

7 

3 

3 

22 

27 

33 

43 

29 

28 

23 

28 

20 

5 

3 

118 

9 

11 

17 

16 

10 

8 

12 

13 

7 

1 

7 

9 

11 

21 

16 

16 

10 

14 

12 

4 

2 

1 

3 

2 

3 

1 

1 

1 

1 

5 

4 

3 

3 

2 

3 

1 

1 

2184 

3016 

4048 

4841 

5614 

6437 

7367 

8374 

8205 

6541 

4030 

119  to  153 

610 

884 

1214 

1562 

1926 

2416 

2923 

3472 

3430 

2858 

1758 

1040 

1347 

1715 

2049 

2481 

2717 

3089 

3466 

3596 

2886 

1870 

132 

237 

363 

456 

506 

617 

698 

732 

646 

479 

195 

402 

548 

756 

774 

701 

687 

657 

704 

533 

318 

207 

330 

367 

414 

439 

429 

450 

446 

397 

312 

219 

109 

119 

133 

153 

154 

146 

148 

143 

166 

150 

123 

82 

38 

122 

127 

148 

174 

175 

178 

144 

152 

121 

87 

41 

30 

41 

50 

53 

50 

51 

59 

47 

33 

28 

12 

45 

46 

62 

66 

56 

78 

77 

48 

35 

22 

18 

1187 

1883 

2719 

3605 

4472 

5491 

6435 

7424 

7252 

5776 

3572 

120 

442 

691 

1001 

1371 

1709 

2174 

2590 

3039 

2934 

2417 

1485 

530 

770 

1088 

1427 

1859 

2282 

2751  3158 

3335 

2699 

1752 

79 

176 

286 

367 

420 

507 

569 

613 

524 

375 

156 

136 

246 

344 

440 

484 

528 

525 

614 

459 

285 

179 

1 

1 

121 

1 

1 

342 


MORTALITY   STATISTICS  OF   INSURED  WAGE   EARNERS. 


NUMBER  OF  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Int'l  i  i-t 
Number. 

Cause  of  De*tb. 

Ate  Periods. 

All 
•CM—  1 

yr.  and 
over. 

1  to4. 

6toO. 

10  to 

14. 

16  to 
10. 

20  to 
24. 

122 

123 
124 
125 

126 
127 

128 

Other  diseases  of  the  kidneys 
and  annexa  

861 

302 
401 
86 
72 

322 

174 
116 
24 
8 

611 

320 
141 
109 
41 

202 

110 
13 

77 
2 

1162 
928 

32 

17 
10 
2 
3 

1 
1 

5 
2 

20 

7 
9 
3 
1 

6 

4 
2 

2 
2 

16 

8 
5 
2 

1 

4 

3 
1 

2 

1 

1 

23 

8 
10 
1 
4 

10 

4 
4 
1 

1 

4 
1 

1 

1 
1 

38 

12 
21 
1 
4 

20 

16 
3 
1 

12 

5 
5 
1 
1 

4 

2 

1 
1 

^Thite  males            

White  females             

Colored  males  

Colored  females  

Calculi  of  the  urinary  passages. 
White  males  

White  females  

Colored  males  

Colored  females  

Diseases  of  the  bladder  

White  males  

\Vhite  females 

Colored  males  

1 
2 

1 
1 

Colored  females  

Diseases  of  the  urethra, 
urinary  abscess,  etc  

White  males  

White  females 

Colored  males  

Colored  females  

Diseases  of  the  prostate  

2 
2 

3 

1 

White  males  

White  females  

Colored  males           .             .  . 

234 

2 

Non  venereal  diseases  of  the 
male  genital  organs  

56 
35 

4 
4 

1 
1 

2 

2 

1 
1 

1 
1 

White  males  

White  females  

Colored  males  

21 

Colored  females  

Uterine  hemorrhage  (non- 
puerperal)  

67 

1 

3 

4 

White  males  

White  females  

53 

1 

3 

4 

Colored  males  

Colored  females  

14 

APPENDIX   A. 


343 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age 

Period! 

. 

Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

49 

46 

75 

76 

66 

83 

75 

76 

82 

60 

44 

122 

14 

14 

23 

21 

19 

23 

26 

29 

36 

28 

17 

27 

25 

40 

34 

36 

43 

32 

32 

31 

25 

21 

3 

1 

8 

14 

8 

10 

10 

9 

5 

6 

3 

5 

6 

4 

7 

3 

7 

7 

6 

10 

1 

3 

15 

21 

30 

18 

22 

29 

37 

43 

29 

25 

12 

123 

9 

11 

17 

5 

11 

13 

18 

24 

18 

13 

7 

4 

7 

13 

10 

10 

13 

15 

15 

8 

7 

4 

2 

2 

1 

1 

4 

4 

2 

5 

1 

1 

3 

2 

1 

19 

13 

15 

21 

37 

36 

50 

87 

113 

121 

74 

124 

3 

6 

4 

6 

13 

13 

27 

48 

68 

78 

43 

6 

4 

5 

6 

10 

12 

7 

17 

20 

23 

23 

7 

2 

4 

5 

9 

9 

11 

17 

21 

16 

5 

3 

1 

2 

4 

5 

2 

5 

5 

4 

4 

3 

15 

20 

21 

12 

29 

20 

31 

20 

21 

2 

5 

125 

5 

8 

8 

4 

13 

14 

18 

16 

15 

2 

3 

1 

2 

2 

1 

3 

2 

1 

9 

10 

11 

7 

12 

6 

10 

4 

6 

1 

1 

1 

3 

2 

6 

14 

16 

61 

108 

200 

282 

284 

181 

126 

2 

5 

8 

11 

30 

77 

163 

229 

236 

164 

1 

2 

1 

6 

5 

31 

31 

37 

53 

48 

17 

3 

4 

4 

4 

2 

8 

5 

4 

9 

3 

1 

127 

2 

1 

1 

1 

1 

6 

1 

3 

7 

2 

1 

1 

3 

3 

3 

1 

2 

4 

1 

2 

1 

9 

11 

9 

8 

7 

4 

3 

3 

2 

1 

2 

128 

7 

9 

6 

6 

6 

3 

3 

3 

2 

2 

2 

3 

2 

1 

1 

2 

1 

344 


MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


NUMBER  or   DEATHS   FROM    EACH   SPECIFIED   DISEASE   OR 
Metropolitan  Life  Insurance  Company  Industrial 


Inl'l  LJflt 
Number. 

<  uii.i.-  of  Death. 

All 

age»—  l 
yr.and 
over. 

Age  Period*. 

Ito4. 

5to0. 

10  to 

14. 

16  to 
19. 

20  to 
24. 

129 
130 
131 

132 
133 
134  to  141 
134 

Uterine  tumor  (noncancerous).. 
Whit©  males            

1335 

8 

17 

White  females         

706 

... 

2 

« 

Oolorwi  males                 ,  ,  ,  ,  t  , 

Colored  females  

630 
786 

1 

5 

6 
46 

8 
72 

Other  diseases  of  the  uterus.  .  .  . 
^^hite  males                   

^Vhite  females                       .  .  . 

600 

1 

5 

28 

60 

Colored  males 

Colored  females  

186 
508 

1 

1 

18 
7 

12 
30 

Cysts  and  other  tumors  of 
the  ovary  

White  males  

White  females  

400 

1 

1 

6 

27 

Colored  males          .        ..... 

Colored  females  

108 
1782 

1 

2 

2 

1 
103 

3 
282 

Salpingitis  and  other  diseases  of 
the  female  genital  organs.  .  . 

^7hite  males     

White  females  

1151 

1 

1 

1 

64 

196 

Colored  males 

Colored  females  

631 

37 

2 
30 

1 

1 

49 

86 
1 

Nonpuerperal  diseases  of  the 
breast  (cancer  excepted)  .  .  . 

Wrhite  males  .            

W^hite  females 

Colored  males  

5 

10151 

1 
2246 

VII.  THE  PUERPERAL 

STATE  

12 

979 

W^hite  males                 .        .  . 

White  females  

8359 

5 

660 

1865 

Colored  females  

1792 

7 

319 

381 

Accidents  of  pregnancy  

885 

1 

43 

161 

White  males 

White  females  

712 

... 

1 

36 

122 

Colored  females  

173 

... 

7 

30 

APPENDIX   A. 


345 


CONDITION.     CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Ag( 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

Infl  List 
Number. 

53 

139 

253 

265 

270 

123 

85 

66 

30 

24 

12 

129 

18 

56 

89 

128 

178 

84 

58 

37 

17 

20 

9 

35 
112 

* 

83 
110 

164 
101 

137 

97 

92 

83 

39 
52 

27 
39 

19 

28 

13 
25 

4 

7 

3 

8 

130 

76 

82 

75 

74 

69 

41 

32 

21 

23 

6 

7 

36 
52 

28 
56 

26 
76 

23 
67 

14 
60 

11 
39 

7 
29 

7 
24 

2 
39 

1 

18 

1 
9 

131 

33 

40 

53 

52 

51 

26 

28 

22 

33 

18 

9 

19 

16 

23 

15 

9 

13 

1 

2 

6 

332 

342 

318 

210 

117 

37 

21 

8 

7 

132 

211 

223 

191 

134 

82 

31 

14 

6 

6 

121 

119 

127 

76 

35 

6 

7 

2 

1 

5 

2 

•; 

4 

4 
1 

4 

3 

4 

1 

1 

1 

133 

6 

2 

5 

3 

2 

4 

3 

i 

1 

1 

1 

1 

1 

1 

» 

i 

2357 

2171 

1644 

659 

76 

6 

1 

134  to  141 

1986 

1822 

1392 

563 

62 

8 

1 

371 

349 

252 

96 

14 

3 

218 

220 

173 

59 

9 

1 

134 

178 

179 

141 

48 

7 

46 

41 

32 

11 

2 

1 

346 


MORTALITY    STATISTICS   OF   INSURED   WAGE    EARNERS. 


NUMBER  OF   DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Age  Pi 

Tlods. 

lril'1  1.1-t 
Number. 

CauM  of  Death. 

All 

BgW—  1 

yr.  and 
over. 

1  to  4. 

5  too. 

10  to 
14. 

15  to 
19. 

20  to 
24. 

135 

Puerperal  hemorrhage  

791 

26 

109 

White  males  

White  females  

681 

22 

86 

Colored  females            

110 

3 

23 

136 

Other  accidents  of  labor  

1036 

3 

61 

200 

White  males  

White  females  

838 

2 

38 

159 

Colored  males  

Colored  females              

198 

1 

23 

41 

137 

Puerperal  septicemia  

4348 

4 

449 

1036 

White  males  

White  females  

3512 

1 

291 

849 

Colored  males  

Colored  females        

836 

3 

158 

187 

138 

Puerperal  albuminuria  and 
convulsions  

2675 

4 

385 

671 

White  males  

White  females  

2249 

1 

259 

584 

Colored  males  . 

Colored  females 

426 

3 

126 

87 

139 

Puerperal  phlegmasia  alba 
dolens,  embolus,  sudden 
death  

369 

13 

61 

White  males  

White  females  

327 

12 

67 

Colored  males  

Colored  females  

42 

1 

4 

140 

Following  childbirth  (not 
otherwise  defined)  

43 

2 

8 

White  males  

White  females  

36 

1 

8 

Colored  males  

Colored  females  

7 

1 

141 

Puerperal  diseases  of  the  breast 
White  males  

4 

1 

... 

White  females  

4 

1 

Colored  females  

APPENDIX   A. 


347 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

171 

188 

199 

87 

11 

1 

135 
136 
137 

138 

139 

140 
141 

147 

160 

176 

79 

10 

1 

24 
233 

28 
235 

23 
196 

8 
95 

1 

10 

3 

193 

191 

162 

84 

7 

2 

40 

1087 

44 
926 

34 
602 

11 
221 

3 

22 

1 

1 

896 

771 

502 

185 

16 

1 

191 
542 

155 
509 

100 
383 

36 
164 

6 

17 

484 

439 

327 

140 

15 

58 
92 

70 

82 

56 
85 

24 
29 

2 
6 

1 

76 

74 

79 

23 

6 

16 

12 

8 
11 

6 
5 

6 

4 

1 

1 

10 

8 

4 

4 

1 

2 

2 

3 

1 

1 

2 

1 

348 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  OF  DEATHS   FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  u<t 
Number. 

Cause  of  Death. 

Age  Period*. 

All 

age*—  1 

yr.  and 
over. 

1  to  4. 

5  too. 

10  to 
14. 

15  to 
10. 

20  to 
24. 

142  to  145 

142 
143 
144 
145 

146  to  149 
146 

VIII.     DISEASES  OF  THE 
SKIN  AND  OF  THE 
CELLULAR  TISSUE  

White  males  

1529 

632 
602 
134 
161 

84 

35 
45 
2 
2 

41 

13 

24 
3 

1 

23 

11 
9 
2 

1 

37 

23 
7 
5 

2 

41 

19 
11 
5 
6 

White  females     

Colored  males       

Colored  females  

Gangrene  

681 

248 
278 
73 
82 

215 

133 
70 
3 
9 

360 

176 
126 
37 
21 

273 

75 
128 
21 
49 

1266 

649 
480 
64 
73 

23 

10 
12 

1 

8 

4 

4 

18 

4 
11 
3 

3 

1 
1 
1 

10 

6 
4 

5 

2 

3 

9 

7 
1 

1 

12 

5 
3 
3 
1 

7 

4 

1 

2 
16 

9 
3 

2 
2 

6 

1 
4 

White  males  

White  females  

Colored  males    

Colored  females  

Furuncle      

White  males  

White  females  

Colored  males  

Colored  females  

Acute  abscess  

41 

15 
24 
2 

12 

6 
5 

19 

7 
11 

1 

4 

2 
2 

8 

3 

4 

1 

2 
1 

22 

14 
5 

1 
2 

1 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Other  diseases  of  the  skin  and 
annexa  

White  males  

White  females     

Colored  males              

Colored  females  

1 

148 

77 
62 
3 
6 

180 

78 
92 
4 
6 

1 

180 

112 
61 
3 
4 

126 

90 
27 
6 
3 

1 

58 

29 
21 
2 
6 

IX.     DISEASES  OF  THE  BONES 
AND  OF  THE  ORGANS 
OF  LOCOMOTION  

White  males  

White  females  

Colored  males  

Colored  females  

Diseases  of  the  bones  (tuber- 
culosis excepted)  

1109 

576 
415 
58 
60 

140 

73 

58 
3 
6 

169 

74 
85 
4 
6 

168 

104 
58 
3 
3 

116 

81 
26 
6 
3 

53 

27 
20 
2 

4 

White  males  

White  females           

Colored  males                 

Colored  females  

APPENDIX   A. 


349 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

69. 

64. 

69. 

74. 

over. 

32 

67 

55 

82 

103 

125 

128 

182 

183 

204 

142 

142  to  145 

15 

28 

25 

34 

49 

53 

46 

69 

63 

82 

67 

11 

19   18 

28 

34 

41 

50 

75 

82 

88 

60 

10    4 

12 

9 

17 

12 

15 

15 

15 

8 

6 

10    8 

8 

11 

14 

20 

23 

23 

19 

7 

2 

18    14 

18 

26 

52 

47 

99 

109 

136 

99 

142 

1 

5    6 

9 

8 

18 

19 

33 

32 

50 

45 

1 

6    5 

4 

11 

16 

15 

43 

49 

60 

41 

3    1 

2 

3 

11 

4 

10 

10 

12 

7 

4    2 

3 

4 

7 

9 

13 

18 

14 

6 

6 

10   11 

19 

25 

33 

21 

18 

18 

13 

7 

143 

6 

6 

7 

10 

15 

16 

14 

11 

11 

12 

5 

1 

4 

3 

8 

7 

15 

5 

7 

7 

1 

2 

1 

1 

1 

3 

2 

1 

11 

31 

17 

31 

28 

24 

27 

38 

19 

17 

11 

144 

6 

16 

9 

12 

21 

14 

6 

19 

10 

7 

8 

4 

6 

5 

11 

3 

5 

14 

14 

7 

8 

2 

6 

1 

7 

2 

4 

6 

3 

1 

1 

1 

3 

2 

1 

2 

1 

1 

2 

1 

1 

1 

13 

8 

13 

14 

24 

16 

33 

27 

37 

38 

25 

145 

3 

1 

3 

3 

5 

5 

7 

6 

10 

13 

9 

5 

3 

5 

5 

13 

5 

16 

11 

19 

19 

15 

1 

1 

3 

4 

2 

1 

2 

4 

2 

1 

5 

3 

A 

3 

2 

4 

9 

8 

4 

4 

74 

50 

51 

50 

64 

55 

62 

54 

49 

37 

28 

146  to  149 

39 

18 

19 

20 

35 

23 

27 

28 

22 

21 

11 

28 

19 

20 

23 

18 

20 

25 

20 

21 

10 

13 

4 

7 

8 

4 

5 

3 

5 

3 

3 

3 

1 

3 

6 

4 

3 

6 

9 

5 

3 

3 

3 

3 

58 

43 

43 

42 

54 

44 

49 

42 

38 

27 

23 

146 

32 

15 

16 

17 

30 

18 

21 

23 

18 

18 

9 

20 

16 

16 

19 

15 

16 

20 

15 

14 

6 

11 

4 

7 

7 

3 

6 

2 

4 

3 

3 

1 

1 

2 

5 

4 

3 

4 

8 

4 

1 

3 

2 

2 

350 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  or   DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  1.  1st 
Number. 

duM  of  Death. 

Age  Period*. 

All 

ice*  —  1 

yr.and 
over. 

Ito4. 

fitoo. 

10  to 
14. 

ifito 
18. 

30  to 
24. 

147 

148 
149 

150 
150 

154 
154 

Diseases  of  the  joints  (tubercu- 
losis and  rheumatism  ex- 
cepted)  

120 

53 
53 
5 
9 

6 
5 

6 

2 

4 

9 

3 
6 

12 

8 
3 

7 

6 
1 

4 
2 

T^hite  males              

Colored  males  

Colored  females  

1 

1 
1 

2 

Amputations  

White  males  

Colored  females  

1 

31 

15 

12 

1 
3 

320 

177 
121 
15 
7 

Other  diseases  of  the  organs 
of  locomotion  

2 
2 

2 

1 
1 

2 
2 

1 

i 

White  males  

White  females  

Colored  males  

Colored  females  

X.  MALFORMATIONS  

181 

103 
63 
11 

4 

66 

32 
30 
3 

1 

21 

14 
6 

1 

15 

10 
6 

7 

6 

1 

White  males  

White  females  

Colored  males  

Colored  females  

Congenital  malformations  (still- 
births not  included)    

320 

177 
121 
15 
7 

3480 

994 
1889 
220 
377 

181 

103 
63 
11 
4 

66 

32 
30 
3 
1 

21 

14 
6 
1 

15 

10 
6 

7 

6 
i 

White  males  

White  females  

Colored  males  

Colored  females  

XII.  OLD  AGE  

White  males  

White  females  

Colored  males  

Colored  females  

Senility  

3480 

994 
1889 
220 
377 

White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


351 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 
Number. 

26  to 
20. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

13 

5 

8 

6 
£ 

i 

8 

4 

I 

7 

£ 

4 
1 

9 

6 
2 

8 
1 

10 

4 
5 
1 

8 

4 
3 

6 

2 
4 

5 

4 
1 

2 
1 

147 
148 

149 
150 

150 
154 
154 

3 

1 

3 
2 

1 

1 
1 

1 

1 
1 

1 

3 
2 

i 

1 
1 

1 
1 

3 

2 
1 

3 

5 

2 
3 

4 
2 
1 

3 

1 
2 

i 

2 

1 

6 

3 
2 

1 

1 

1 

11 

3 

8 

4 

3 
1 

3 

1 

1 

3 

1 
2 

1 
1 

1 

1 

1 

1 

1 

6 

3 

2 

11 

3 

8 

4 

3 
1 

3 

1 
1 

3 

1 
2 

1 
1 

1 

1 

1 

1 

1 

1 

6 

1 
1 
2 
2 

20 

6 
9 
4 
1 

72 

16 
33 
8 
15 

287 

65 
132 
32 
58 

605 

159 

317 
48 
81 

1167 

344 
652 
71 
100 

1323 

403 
745 
55 
120 

6 

1 
1 
2 
2 

20 

6 
9 
4 

1 

72 

16 
33 
8 
15 

287 

65 
132 
32 

58 

605 

159 
317i 
48 
81| 

1167 

344 
652 
71 
100 

1323 

403 
745 
55 
120 

362          MORTALITY    STATISTICS  OF   INSURED   WAGE   EARNERS. 


NUMBER  01    DEATHS   FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


ll.fl  I.IM 

Number. 

rauiH-  of  i>f«ui. 

Age  Periods. 

All 

ace*—  1 
yr.  and 
over. 

l  to4. 

5to9. 

lOto 
14. 

15to 
19. 

20  to 
24. 

155  to  186 
155  to  163 

155 
156 
157 

158 
159 

XIII.  EXTERNAL  CAUSES*: 
White  mules  

60712 

31381 
11618 
5610 
2103 

4259 

2160 
1662 
238 
199 

3788 

2344 
1064 
216 
164 

2809 

2004 
444 
281 
80 

4113 

2717 
712 
556 
128 

4847 

3174 
747 
670 
256 

White  females  .    .  ,  

Colored  males        

Colored  females          

Suicide  (total)  

6542 

4309 
1748 
308 
177 

2352 

1280 
874 
89 
109 

1040 

633 
386 
14 

7 

761 

626 
106 
24 
5 

316 

176 
109 
16 
15 

1519 

1210 
152 
129 
28 

27 

15 
8 
2 
2 

8 

1 
6 
1 

2 

1 
1 

364 

135 

195 
16 
18 

199 

45 
137 
4 
13 

26 

12 
14 

707 

391 
226 
45 
45 

338 

145 
152 
9 
32 

47 

29 
16 

White  males  

White  females  

Colored  males  

Colored  females  

Suicide  by  poison  

White  males     .        

White  females  

Colored  males  

Colored  females  

Suicide  by  asphyxia      

White  males  

White  females  

... 

Colored  males          

Colored  females              

2 

42 

30 
7 
5 

24 

9 

7 
4 

4 

225 

159 
38 
24 

4 

Suicide  by  hanging  or 
strangulation   

7 
7 

1 

1 

8 
6 

1 
1 

23 

1 

! 

20 

4 
14 
1 
1 

81 

50 
23 
6 
2 

White  males  

White  females  

Colored  males  

Colored  females  

Suicide  by  drowning  

White  males  

... 

White  females  

Colored  males  

Colored  females  

Suicide  by  firearms  

White  males  

White  females  

Colored  males  

Colored  females  

*  Includes  war  deaths  (1,149). 


APPENDIX    A. 


353 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age 

Periods 

i. 

Tnl'l  List 

25  to 

30  to 

36  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

4245 

3813 

3460 

3189 

2983 

2968 

2722 

2574 

2177 

1692 

1073 

155  to  186 

2598 

2303 

2183 

2106 

2004 

1969 

1811 

1600 

1210 

797 

401 

622 

615 

521 

524 

544 

628 

634 

742 

774 

780 

605 

784 

676 

600 

432 

329 

281 

205 

154 

108 

54 

26 

241 

219 

156 

127 

106 

90 

72 

78 

85 

61 

41 

724 

711 

666 

640 

598 

620 

527 

431 

304 

152 

71 

155  to  163 

421 

401 

425 

429 

433 

466 

413 

347 

254 

118 

61 

218 

235 

170 

173 

139 

128 

97 

72 

44 

33 

10 

52 

48 

48 

26 

19 

20 

14 

12 

6 

33 

27 

23 

12 

7 

6 

3 

1 

337 

314 

227 

240 

157 

178 

135 

113 

68 

30 

8 

155 

159 

157 

134 

147 

98 

126 

98 

86 

59 

19 

6 

142 

115 

67 

76 

54 

43 

34 

26 

9 

11 

2 

16 

22 

12 

12 

4 

6 

2 

1 

20 

20 

14 

5 

1 

3 

1 

87 

103 

122 

122 

115 

129 

113 

77 

57 

33 

7 

156 

50 

50 

59 

66 

71 

85 

82 

57 

45 

22 

4 

33 

51 

60 

54 

43 

43 

29 

17 

11 

11 

3 

3 

1 

2 

1 

1 

2 

3 

1 

1 

1 

1 

1 

1 

40 

51 

58 

58 

74 

86 

91 

97 

76 

35 

23 

157 

34 

36 

51 

44 

60 

73 

71 

85 

67 

32 

20 

4 

13 

2 

14 

13 

10 

15 

10 

9 

3 

3 

1 

2 

3 

3 

5 

2 

1 

2 

1 

31 

33 

29 

25 

30 

37 

20 

31 

22 

8 

5 

158 

20 

14 

14 

15 

18 

23 

13 

23 

13 

5 

5 

7 

17 

11 

7 

8 

14 

6 

7 

9 

2 

2 

1 

2 

3 

2 

1 

2 

1 

2 

2 

1 

1 

175 

156 

162 

132 

152 

130 

122 

80 

52 

29 

15 

159 

128 

109 

122 

111 

134 

113 

113 

73 

49 

28 

15 

14 

25 

13 

14 

9 

7 

5 

2 

1 

1 

! 

126 

18 

24 

4 

8 

8 

3 

5 

2 

\ 

7 

4 

3 

3 

1 

2 

1 

\ 

354 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  cr  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


lllfl  1  .1.11 
Number. 

Cauae  of  Death. 

Age  Fcrtode. 

All 

ages  —  1 
jr.  and 
over. 

1  I..4. 

5toO. 

10  to 
14. 

16  to 
10. 

JO  t.) 

24. 

160 
161 

162 
163 

164 
165 

Suicide  by  cutting  or 
piercing  instruments  

346 

272 
47 
24 
3 

107 

58 

38 
7 
4 

3 

1 
1 
1 

15 
11 

3 
1 

White  males  

White  females  

Colored  males  

Colored  females  

Suicide  by  jumping  from 
high  places  

5 

3 
2 

4 

2 
1 

1 

White  males  

White  females  

Colored  males  

Colored  females  

Suicide  by  crushing  

33 

25 
5 
3 

... 

3 
2 

6 

4 

1 
1 

White  males.  .  .        

White  females  

Colored  males  

1 

Colored  females  

Other  suicides  

68 

29 
31 
2 
6 

39268 

24794 
9356 
3705 
1413 

622 

265 
248 
45 
64 

1144 

515 
475 
82 
72 

1 

i 

4 

2 
1 

6 

2 
1 

White  males  

White  females  

Colored  males  

Colored  females  

4228 

2149 
1644 
236 
199 

183 

94 
73 
7 
9 

357 

162 
147 
30 
18 

3740 

2323 
1048 
209 
160 

87 

42 
36 

4 

61 
34 

I 

2720 

1963 
420 
264 
73 

38 

18 
14 
3 
3 

16 
0 

4 

'2 

1 

3241 

2308 
459 
412 
62 

24 

8 
12 
1 
3 

49 

14 

32 

! 

3 

3027 

2170 
427 
333 
97 

28 

11 
10 
5 
2 

91 

30 
44 
6 
11 

Accidents  or  undefined  vio- 
lence (total)  *  

White  males  

White  females  

Colored  males  

Colored  females  

Poisoning  by  food  

White  males  

White  females  

Colored  males  

Colored  females  

Other  acute  poisonings  
White  males  

White  females  

Colored  males  

Colored  females  

Includes  titles  164  to  181  inclusive,  185  and  186,  but  excludes  "war 


APPENDIX   A. 


355 


CONDITION.    CLASSIFIED  BY  COLOB,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

60. 

74. 

over. 

25 

28 

42 

46 

53 

44 

30 

21 

20 

10 

9 

160 

18 

22 

35 

37 

42 

35 

23 

17 

14 

9 

8 

4 

3 

4 

4 

6 

7 

5 

4 

4 

1 

1 

3 

3 

3 

4 

3 

2 

2 

2 

.  1 

2 

16 

13 

18 

11 

9 

9 

5 

5 

7 

4 

1 

161 

7 

9 

6 

6 

6 

7 

3 

2 

5 

1 

1 

7 

4 

9 

2 

2 

2 

2 

3 

1 

3 

1 

2 

1 

1 

1 

1 

1 

2 

3 

2 

3 

1 

2 

3 

5 

2 

2 

1 

162 

2 

2 

2 

1 

2 

5 

2 

2 

1 

1 

1 

1 

1 

1 

163 

10 

11 

5 

5 

6 

4 

6 

5 

3 

2 

3 

2 

2 

3 

3 

2 

5 

2 

2 

1 

6 

7 

3 

2 

3 

1 

1 

3 

1 

1 

1 

1 

1 

1 

2574 

2327 

2274 

2195 

2175 

2203 

2105 

2089 

1843 

1532 

995 

1787 

1582 

1546 

1522 

1482 

1434 

1347 

1226 

940 

675 

340 

324 

317 

304 

307 

383 

475 

527 

659   726 

743 

593 

369 

339 

340 

284 

227 

220 

169   132 

94 

54 

23 

94 

89 

84 

82 

83 

74 

62 

72 

83 

60 

39 

25 

37 

23 

33 

26 

30 

27 

21 

20 

12 

8 

164 

10 

12 

7 

13 

10 

10 

9 

10 

6 

4 

1 

9 

15 

8 

8 

10 

9 

11 

8 

13 

5 

7 

2 

3 

3 

4 

2 

6 

4 

1 

4 

7 

5 

8 

4 

5 

3 

3 

1 

2 

,104 

86 

67 

66 

60 

47 

43 

41 

24 

23 

9 

165 

38 

33 

19 

31 

35 

29 

21 

29 

11 

15 

6 

49 

41 

38   21 

19 

12 

19 

10 

12 

6 

4 

11 

4 

6 

7 

2 

3 

3 

2 

6 

8 

4 

7 

4 

3 

2 

1 

deaths"  (x-186). 


366 


MORTALITY    STATISTICS   OF    INSURED    WAGE    EARNERS. 


NUMBER  OK    I>EATHS   FROM    EACH   SPECIFIED   DISEASE   OR 
Metropolitan  Life  Insurance  Company  Industrial 


Ace  Pi 

alodi. 

Il.M    !   l-t 

Number. 

CMM  of  Death. 

All 
ago—  1 

yr.  ami 
over. 

1  to  4. 

6  toO. 

10  to 

14. 

16  to 
10. 

20U> 
24. 

166 

Conflagration  

576 

101 

64 

30 

24 

34 

White  males                        .... 

257 

45 

28 

7 

10 

11 

White  females  .        

185 

30 

24 

15 

11 

13 

Colored  males         

62 

12 

1 

| 

3 

6 

Colored  females      

72 

14 

11 

3 

4 

167 

Burns  (conflagration 
ezcepted)  

4714 

1977 

760 

174 

130 

162 

White  males  

1545 

912 

227 

35 

29 

38 

White  females  .        

2393 

828 

410 

108 

73 

86 

Colored  males  

255 

116 

29 

8 

8 

9 

Colored  females  

521 

121 

94 

23 

20 

29 

168 

Absorption  of  deleterious 
gases  (conflagration 
ezcepted)  

1431 

46 

48 

53 

68 

97 

White  males  .  .      .        

843 

21 

24 

36 

31 

59 

White  females  

485 

21 

23 

13 

32 

28 

Colored  males  

69 

2 

2 

3 

5 

Colored  females  

34 

2 

1 

2 

2 

5 

169 

Accidental  drowning  

5757 

280 

742 

915 

1031 

694 

White  males  

4310 

194 

627 

717 

737 

479 

White  females  

661 

74 

77 

179 

128 

113 

Colored  males  

708 

9 

33 

110 

157 

92 

Colored  females  

78 

3 

5 

9 

9 

10 

170 

Traumatism  by  firearms.  .  . 
White  males  

1029 
637 

39 
19 

100 
63 

209 
162 

244 
161 

136 

77 

White  females  

89 

11 

14 

9 

23 

4 

Colored  males  

248 

4 

18 

33 

58 

41 

Colored  females  

55 

6 

5 

5 

2 

14 

171 

Traumatism  by  cutting  or 
piercing  instruments  

93 

9 

10 

10 

5 

9 

White  males  

51 

3 

8 

8 

2 

4 

White  females  

16 

6 

1 

2 

1 

1 

Colored  males  

21 

1 

2 

4 

Colored  females  

6 

172 

Traumatism  by  fall  

6917 

454 

311 

201 

208 

241 

White  males  

4021 

249 

204 

145 

158 

191 

White  females  

2297 

159 

78 

32 

27 

24 

Colored  males  

405 

31 

23 

16 

17 

17 

Colored  females  

194 

15 

6 

8 

6 

0 

APPENDIX    A. 


357 


CONDITION.     CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Inn  List 
Number. 

25  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

eo  to 

64. 

05  to 
69. 

70  to 
74. 

75  and 
over. 

25 

35 

42 

33 

34 

31   31 

27 

28 

24 

13 

166 

12 

18 

27 

20 

19 

18    15 

6 

9 

10 

2 

8 

5 

9 

8 

7 

6    10 

11 

9 

10 

9 

3 

5 

O 

2j    7 

4    2 

5 

3 

1 

2 

7 

3 

3 

1 

3 

4 

5 

7 

3 

2 

145 

123 

133 

135 

140 

170 

146 

159 

149 

124 

87 

167 

28 

29 

36 

28 

33   36   32 

29 

17 

24 

12 

84 

66 

65   79 

81   99   88!   96 

93 

78 

59 

9 

11 

10   13 

6    6    4!    9 

9 

5 

3 

24 

17 

22 

15 

20 

29   22 

25 

30 

17 

13 

94 

100 

97 

113 

123 

127   132 

127 

96 

68 

42 

168 

47 

57 

55 

81 

77   74   83 

80 

58 

40 

20 

34 

27 

30 

22 

34   44   46 

46 

35 

28 

22 

8 

9 

10 

8 

91    8    2 

1 

2 

5 

7 

2    2 

3i    1    1 

1 

432 

328 

259 

241   232 

197 

156 

109 

82 

40 

19 

169 

299 

224 

184   188 

167   154 

134 

88 

68 

34 

16 

42 

28 

20    17 

27   20 

11 

10 

9 

3 

3 

84 

71 

47   31 

30   20 

8 

9 

4 

3 

7 

5 

Q 

5 

g 

3 

3 

2 

1 

82 

69 

58 

34 

10 

17 

7 

13 

7 

4 

170 

38 

35 

27 

17 

5 

13 

5    8 

6 

1 

3 

3 

8 

2 

3 

2 

4 

1 

2 

34 

28 

17 

9 

2 

2j    1 

1 

7 

3 

6 

6 

2 

12 

7 

6 

6 

4 

5 

4 

4 

1 

1 

171 

4 

5 

2 

3 

2 

2 

3 

4 

1 

1 

1 

1 

1 

7 

2 

2 

3 

2 

1 

1 

2 

267 

341 

410 

419 

457 

504 

549 

653 

687 

707 

508 

172 

199 

257 

304 

318 

313 

324 

330 

338 

289 

255 

147 

30 

49 

52 

58 

98 

136 

169 

271 

356 

414 

344 

26 

28 

46 

35 

35 

33 

35 

27 

22 

9 

6 

12 

7 

8 

8 

11 

11 

15 

17 

20 

29 

12 

358 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  or  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  i  i-t 

NuralHT. 

Cttwe  of  Death. 

Ace  Period*. 

All 
«ge»—  I 

>  r.  and 
over. 

1  to  4. 

A  toO. 

10  to 
14. 

15  to 
10. 

20  to 
24. 

A173 
B173 
174 
A175 

B175 
C175 
D175 

Traumatism  in  mines  

612 

505 
3 
104 

1 

15 

9 
1 
5 

100 
89 

79 
70 

White  males  

White  females  

1 

Colored  males  

11 

9 

Colored  females        

Traumatism  in  quarries.  .  .  . 
White  males  

48 

40 
1 

7 

1 

1 

8 
8 

2 
2 

White  females  

Colored  males     

Colored  females          .  . 

Traumatism  by  machines  .  . 
White  males  

905 

720 
32 
148 
5 

4485 

3598 
301 
527 
59 

1600 

1130 
312 
124 
34 

250T 

1737 
585 
139 
46 

1658 

1226 
242 
170 
20 

7 

4 
2 

1 

10 

7 
2 
1 

30 

26 

1 
2 

1 

228 

185 
19 
22 
2 

104 

78 
17 
6 
3 

335 

257 
53 
20 
5 

107 

83 
14 

9 

1 

140 

112 
9 
16 
3 

508 

409 
32 
62 
5 

96 

66 
14 
14 
2 

177 

132 
33 
11 
1 

112 

82 
13 
14 
3 

113 

97 
2 
14 

644 

546 
18 
76 

4 

75 

58 
10 
6 

1 

176 

129 
38 
6 
3 

110 

88 
14 
8 

White  females  

Colored  males  

Colored  females  

Railroad  accidents  and 
injuries  

48 

32 
15 
1 

120 

63 
51 
3 
3 

165 

96 
61 
6 
2 

170 

97 
66 
4 
3 

171 

132 
27 
11 
1 

186 

120 
52 
10 
4 

625 

423 
160 
32 
10 

273 

202 
50 
17 
4 

White  males  

White  females  

Colored  males  

Colored  females  

Street-car  accidents  and 
injuries  

White  males  

White  females  

Colored  males  

Colored  females  

Automobile  accidents  and 
injuries  

White  males  

White  females  

Ool  orf*d  males  ,  .  .  .  ,  

Colored  females  

Injuries  by  other  vehicles  .  . 
White  males  

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


359 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

69. 

64. 

69. 

74. 

over. 

80 

61 

58 

50 

48 

45 

37 

21 

14 

3 

A173 

69 

48 

39 

39 

40 

38 

30 

19 

12 

3 

1 

11 

13 

19 

11 

8 

7 

7 

2 

1 

... 

3 

6 

6 

3 

5 

6 

3 

2 

2 

1 

B173 

2 

6 

4 

3 

3 

5 

3 

2 

1 

1 

i 

1 

2 

1 

1 

1 

... 

69 

93 

93 

73 

82 

67 

59 

34 

24 

7 

4 

174 

49 

68 

69 

64 

69 

46 

50 

30 

21 

7 

1 

1 

3 

2 

4 

1 

1 

2 

2 

19 

21 

22 

9 

13 

17 

8 

3 

1 

1 

1 

557 

396 

344 

323 

261 

258 

228 

250 

149 

83 

37 

A175 

471 

312 

279 

251 

210 

195 

181 

187 

117 

67 

24 

13 

17 

9   14 

13 

28 

20 

39 

17 

13 

7 

67 

60 

50   49 

33 

33 

25 

21 

11 

3 

3 

6 

7!    6    9 

5 

2 

2 

3 

4 

3 

101 

74 

101 

93 

105 

121 

130 

110 

85 

53 

46 

B175 

84 

61 

77 

72 

74 

92 

92 

68 

60 

36 

29 

4 

3 

9 

8   15 

20 

29 

33 

21 

11 

15 

13 

8 

12 

111   10 

6 

8 

7 

3 

5 

2 

2 

3 

2 

6 

3 

1 

2 

1 

1 

153 

101 

97 

103 

108 

94 

109 

115 

79 

49 

21 

C175 

114 

73 

65 

66 

76 

60 

67 

80 

52 

35 

12 

23 

19 

22 

27 

26 

23 

31 

28 

19 

14 

8 

13 

5 

9 

9 

3 

7 

9 

4 

4 

1 

3 

4 

1 

3 

4 

2 

3 

4 

89 

114 

101 

98 

107 

103 

75 

78 

63 

47 

11 

D175 

79 

87 

80 

74 

75 

76 

60 

59 

46 

29 

9 

3 

9 

4 

7 

14 

10 

6 

8 

10 

13 

1 

7 

17 

15 

15 

16 

17 

9 

11 

6 

4 

1 

1 

2 

2 

2 

1 

1 

360 


MORTALITY    STATISTICS   OF    IN8UBED    WAGE    EARNERS. 


NUMBER  or    DEATHS   FROM    EACH   SPECIFIED   DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Age  ft 

rloda. 

Int'l  List 
Number. 

CMIM  of  Death. 

All 

yr.  and 
over. 

Ito4. 

6lo9. 

10  to 
14. 

15lo 
10. 

•JO  to 
24. 

E175 

Landslide,  other  crushing.  .  . 
White  males  .  .           

381 
299 

16 
11 

27 
21 

23 
21 

36 
28 

33 

30 

White  females          

20 

5 

5 

1 

4 

Colored  males                   

58 

1 

4 

3 

Colored  females  

4 

1 

176 

Injuries  by  animals  

233 

12 

27 

22 

15 

15 

White  males  

188 

9 

22 

16 

12 

11 

White  females        

10 

3 

2 

2 

Colored  males  

35 

3 

6 

1 

4 

Colored  females  

177 

Starvation  

16 

1 

White  males     

7 

1 

White  females       

6 

Colored  males  

2 

Colored  females  

1 

178 

Excessive  cold  

217 

2 

3 

3 

8 

11 

White  males  

128 

2 

3 

1 

6 

5 

White  females  

27 

1 

3 

Colored  males  

45 

1 

2 

Colored  females  

17 

1 

1 

1 

179 

Effects  of  heat  

1247 

50 

21 

15 

17 

30 

White  males  . 

720 

29 

12 

9 

12 

20 

White  females          

336 

16 

7 

3 

3 

5 

Colored  males  

132 

1 

1 

1 

2 

4 

Colored  females  

59 

4 

1 

2 

1 

180 

Lightning  

96 

6 

14 

14 

11 

White  males  

71 

5 

10 

13 

8 

White  females  

11 

1 

2 

1 

1 

Colored  males            

14 

2 

2 

Colored  females                ...    . 

181 

Electricity  (lightning 
excepted)  

452 

4 

20 

34 

68 

93 

White  males  

421 

3 

16 

31 

64 

92 

White  females  

8 

1 

2 

2 

Colored  males  

20 

1 

2 

1 

2 

1 

Colored  females  

1 

APPENDIX    A. 


361 


CONDITION.     CLASSIFIED  B?  COLOB,  SEX  AND  BY  AGE  PBRIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Int'l  List 
Number. 

26  to 
29. 

30  to 
34. 

35  to 
39. 

40  to 
44. 

45  to 
49. 

50  to 
54. 

55  to 
59. 

60  to 
64. 

65  to 
69. 

70  to 
74. 

75  and 
over. 

39 

27 

1 
9 
2 

11 

7 
1 
3 

38 
29 
9 

15 
14 
1 

29 

20 

1 
7 
1 

19 

16 
1 

2 

33 

23 
2 

8 

30 
23 

35 
31 

19 
15 

13 
12 

6 

4 

1 
1 

2 
2 

2 

2 

E176 
176 
177 
178 
179 
180 

181 

7 

4 

4 

1 

20 
15 

16 
14 

14 
12 

13 
11 

10 

8 

16 
14 

6 

5 
1 

2 
2 

5 

2 

2 

2 

o 

2 

3 

1 
1 
1 

13 

5 
2 
3 
3 

41 

25 
3 
10 
3 

13 

10 
2 

1 

1 

3 

1 

2 

3 

j 

1 

2 
2 

1 
1 

2 

1 

1 

22 

15 

2 
3 
2 

70 

44 
14 
8 
4 

8 
6 

1 
14 
9 
5 

122 

81 
13 
21 

7 

5 
3 

16 

6 
4 
5 
1 

104 

71 
18 
10 
5 

5 
3 

20 

15 
1 

120 

82 
17 
14 

7 

6 

4 
1 

23 

12 
2 
8 
1 

128 

82 
27 
14 
5 

4 
3 

22 

16 
2 

4 

130 

68 
40 
15 
7 

5 

3 
1 

24 

18 
1 
4 

107 

54 
39 
10 
4 

1 
1 

18 

9 
4 
3 
2 

125 

69 
43 
10 
3 

2 

1 
1 

13 

5 
2 
4 
2 

101 

36 
56 
7 
2 

1 

i 

5 

1 
3 

1 
66 

26 
32 
4 
4 

1 

1 

2 

2 

2 

1 

1 

1 

65 

63 
1 
1 

49 
46 

2 
1 

45 
41 

4 

33 
30 

2 
1 

14 

12 
1 
1 

12 
11 
1 

11 

8 
1 
2 

3 
3 

1 

1 

3G2 


MORTALITY    STATISTICS   OF    INSURED   WAGE    EARNERS. 


NUMBER  OF  DEATHS  FROM   EACH  SPECIFIED  DISEASE  OR 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  I.tot 
Number. 

Cause  of  Death. 

Ate  Periods. 

All 
ages  —  1 
jr.  and 
over. 

Ito4. 

5  to  9. 

10  to 
14. 

16  to 
19. 

20  to 
24. 

185 

186 
(x-186) 
182  to  184 
182 
183 

184 

Fractures  (cause  not 
specified)  

806 

414 
316 
57 
19 

1722 

1146 
298 
228 
50 

1149 

1130 
14 
6 

12 

8 
4 

176 

96 
72 
8 

3 

1 
2 

27 

16 
9 

2 
160 

87 
52 
15 
6 

3 

2 
1 

20 

15 
3 
2 

123 

84 
26 
11 
2 

2 
2 

14 
12 
2 

144 

112 
7 
22 
3 

156 
155 

20 

16 

1 
3 

123 

98 
12 
10 
3 

431 

429 
1 
1 

White  males  

White  females  

Colored  males       

Colored  females  

Other  external  violence  .... 
White  males  

White  females  

Colored  males  

Colored  females  

War  deaths*  

White  males  

White  females  

Colored  males  

1 

Colored  females  

Homicide  (total)  

3753 

1148 
500 
1592 
513 

2435 

691 
292 
1132 
320 

616 

167 
43 
297 
109 

702 

290 
165 
163 
84 

28 

10 
16 
2 

8 

3 
4 
1 

5 

2 
3 

45 

19 
15 
7 
4 

16 

9 

4 
2 
1 

5 

1 
2 

60 

24 
16 
15 
5 

37 

15 

7 
12 
3 

7 

3 
1 
2 
1 

16 

6 

8 
1 

1 

352 

119 

58 
127 
48 

238 

83 
42 
92 
21 

60 

20 
3 
22 
15 

54 

16 
13 
13 
12 

682 

184 
93 
291 
114 

459 

125 
52 
207 
75 

125 

33 

4 
62 
26 

98 

26 
37 
22 
13 

White  males  

White  females  

Colored  males  

Colored  females  

Homicide  by  firearms  

White  males  

White  females  

Colored  males  

Colored  females  

Homicide  by  cutting  or 
piercing  instruments  

White  males  

White  females  

Colored  males  

Colored  females  

15 

5 
9 
1 

2 
24 

9 
9 
5 
1 

Homicide  by  other  means.  . 
White  males  

White  females  

Colored  males  

Colored  females  

Includes  the  two  years  1915  and  1916  only. 


APPENDIX   A. 


363 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age 

Period 

i. 

I  nt  'I  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

20. 

34. 

30. 

44. 

40. 

54. 

60. 

64. 

60. 

74. 

over. 

36 

36 

47 

57 

50 

54 

58 

91 

90 

118 

76 

185 

28 

25 

36 

39 

38 

35 

31 

41 

24 

37 

13 

5 

6 

6 

8 

14 

23 

42 

60 

75 

60 

6 

6 

5 

11 

3 

3 

3 

5 

2 

5 

1 

2 

1 

1 

2 

1 

3 

4 

1 

2 

115 

118 

97 

104 

117 

108 

108 

74 

75 

44 

36 

186 

78 

78 

66 

67 

86 

75 

79 

60 

46 

29 

15 

9 

11 

5 

6 

8 

17 

17 

12 

17 

10 

17 

20 

25 

22 

26 

20 

14 

11 

10 

9 

3 

2 

8 

4 

4 

5 

3 

2 

1 

2 

3 

2 

2 

200 

170 

100 

62 

14 

5 

1 

1 

1 

(x-186) 

194 

168 

99 

60 

14 

3 

1 

1 

1 

5 

2 

1 

1 

1 

1 

1 

1 

747 

605 

420 

292 

196 

140 

89 

63 

29 

8 

7 

182  to  184 

196 

152 

113 

95 

75 

66 

50 

26 

15 

4 

75 

61 

46 

43 

22 

24 

10 

11 

4 

4 

2 

362 

289 

212 

121 

83 

40 

22 

10 

8 

3 

114 

103 

49 

33 

16 

10 

7 

6 

2 

2 

539 

405 

277 

190 

114 

69 

45 

21 

10 

3 

4 

182 

135 

100 

64 

58 

34 

26 

25 

10 

3 

1 

49 

34 

27 

28 

16 

15 

3 

6 

2 

2 

1 

272 

204 

160 

83 

55 

22 

13 

2 

6 

2 

83 

67 

26 

21 

9 

6 

4 

3 

... 

1 

121 

98 

67 

52 

29 

16 

17 

8 

3 

2 

1 

183 

36 

17 

21 

10 

7 

6 

8 

2 

1 

2 

6 

5 

7 

3 

2 

4 

1 

65 

66 

29 

28 

15 

7 

4 

5 

1 

1 

18 

19 

12 

7 

4 

1 

1 

3 

87 

102 

76 

50 

53 

55 

27 

24 

16 

3 

2 

184 

25 

35 

28 

27 

34 

34 

17 

16 

10 

2 

24 

21 

14 

8 

3 

7 

3 

5 

2 

1 

1 

25 

29 

23 

10 

13 

11 

5 

3 

2 

13 

17 

11 

5 

3 

3 

2 

2 

1 

t  Does  not  include  war  deaths  (1,149). 


364 


MORTALITY    STATISTICS    OP    INSURED    WAGE    EARNERS. 


NUMBER  OF   DEATHS   FROM   EACH  SPECIFIED  DISEASE  OB 
Metropolitan  Life  Insurance  Company  Industrial 


Infl  List 
Number. 

C»UM  of  Death. 

Ace  Period*. 

All 
ages  —  1 
yr.  and 
over. 

I  to  4. 

5  tog. 

10  to 
14. 

15  to 
10. 

20  to 
94. 

187  to  189 

187 
188 
189 

XIV.  ILIS-DEFINED 
DISEASES  

5448 

2591 
1504 
731 
622 

404 

173 
132 
59 
40 

90 

35 
31 
11 
13 

71 

30 
23 
12 

6 

109 

40 
35 
17 
17 

215 

72 
60 
40 
43 

White  males  

White  females          

Colored  males  

Colored  females  

Ill-defined  organic  disease  

261 

46 
69 
64 
82 

131 

59 
54 

7 
11 

5056 

2486 
1381 
660 
529 

5 

1 
2 
2 

1 
1 

4 

| 

1 
2 

5 

2 
2 

"! 

6 

6 

White  males  

White  females  

4 
1 
1 

2 

2 

4 

3 

"i 

Colored  males  

Colored  females  

Sudden  death  

White  males  

White  females  

2 

Colored  males  

Colored  females  

i 

206 

72 
58 
38 
38 

Not  specified  or  ill-defined  
White  males  

398 

171 
130 
57 
40 

86 

34 
31 
10 
11 

64 

28 
19 
11 
6 

101 

38 
31 
16 
16 

White  females  

Colored  males  

Colored  females  

APPENDIX   A. 


366 


CONDITION.    CLASSIFIED  BY  COLOR,  SEX  AND  BY  AGE  PERIOD. 
Mortality  Experience,  1911  to  1916. 


Age  Periods. 

Infl  List 

25  to 

30  to 

35  to 

40  to 

45  to 

50  to 

55  to 

60  to 

65  to 

70  to 

75  and 

Number. 

29. 

34. 

39. 

44. 

49. 

54. 

59. 

64. 

69. 

74. 

over. 

307 

406 

483 

450 

465 

466 

493 

538 

470 

323 

158 

187  to  189 

151 

210 

264 

242 

263 

238 

237 

239 

200 

130 

67 

72 

65 

88 

100 

105 

106 

131 

175 

191 

128 

62 

52 

86 

64|   63 

56 

69 

55 

62 

39 

31 

15 

32 

45 

67 

45 

41 

53 

70 

62 

40 

34 

14 

3 

9 

16 

15 

20 

26 

35 

44 

26 

27 

14 

187 

1 

4 

2 

3 

2 

8 

7 

y 

5 

3 

1 

3 

4 

6 

8 

7 

11 

9 

7 

5 

... 

3 

2 

3 

6 

9 

9 

8 

7 

8 

2 

2 

5 

7 

6 

5 

7 

11 

18 

3 

7 

4 

4 

3 

8 

5 

14 

15 

22 

17 

20 

13 

2 

188 

2 

1 

2 

7 

7 

11 

6 

9 

9 

2 

2 

1 

4 

1 

6 

6 

9 

10 

7 

4 

2 

2 

1 

2 

1 

2 

2 

2 

1 

2 

300 

394 

459 

430 

431 

425 

436 

477 

424 

283 

142 

189 

149 

208 

260 

238 

253 

229 

218 

226 

184 

116 

62 

69 

64 

81  !   95 

93 

92 

115 

154 

175 

117 

57 

52 

83 

60   58 

49 

60 

46 

54 

30 

23 

13 

30 

39 

58 

39 

36 

44 

57 

43 

35 

27 

10 

366 


MORTALITY    STATISTICS    OF    INSURED    WAGE    EARNERS. 


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APPENDIX   B. 


367 


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368         MORTALITY    STATISTICS    OF    INSURED    WAGE    EARNERS. 


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APPENDIX  C. 

EFFECT  OF  SYSTEM  OF  INQUIRY  TO  PHYSICIANS  UPON  DEATH 
RATES  OF  PEINCIPAL  DISEASES  AND  CONDITIONS. 

There  are  two  general  sources  of  error  in  the  statistics  of  causes 
of  death.  The  first  source  is  the  inherent  inaccuracy  and  uncer- 
tainty of  the  diagnoses  in  a  fairly  significant  proportion  of  the 
deaths  certified.  This  element  of  defect  in  the  statistics  has  been 
found  upon  recent  inquiry,  however,  not  to  assume  as  much  im- 
portance for  the  chief  diseases  and  conditions  as  was  at  one  time 
thought  to  be  the  case.  Some  committee  work  on  behalf  of  the 
American  Public  Health  Association  by  a  group  of  pathologists, 
clinicians  and  statistical  workers,  has  shown  that  the  statistics  of 
the  causes  of  death  represented  in  contemporary  American  regis- 
tration practice  are,  for  the  most  part,  reliable  for  the  practical 
purposes  of  public  health  work,  and  that  they  are  worth  the  time, 
effort  and  expense  required  for  the  proper  collection,  tabulation 
and  publication  of  the  same.*  This  conclusion,  based  upon  the 
deliberations  of  a  representative  committee,  should  go  far  to  off- 
set the  suspicions  and  the  doubts  as  to  the  accuracy  of  the  statis- 
tics of  certified  causes  of  death  which  have  appeared  in  recent 
vital  statistical  literature. 

The  second  important  source  of  error  in  the  statistics  of  causes 
of  death  arises  from  the  failure  of  certifying  physicians  to  report 
all  the  morbid  conditions  known  to  them  and  which  had  any  bear- 
ing upon  the  cause  of  death.  Physicians  often  report  only  condi- 
tions such  as  "  acute  nephritis,"  "  peritonitis,"  "  septicemia "  and 
other  merely  terminal  incidents  in  the  course  of  the  last  illness. 
This  practice  is  perhaps  excusable  in  view  of  the  fact  that  the 
terminal  condition  is  uppermost  in  the  physician's  mind,  probably 
because  it  required  the  largest  part  of  the  physician's  effort  on 
behalf  of  his  patient.  These  incomplete  statements  of  causes  of 
death  account  for  a  quite  significant  proportion  of  the  total  amount 

*  See  reprints  363  and  440,  from  Reports  of  the  United  States  Public 
Health  Service,  1917  and  1918.  "The  Accuracy  of  Certified  Causes  of 
Death  and  its  Relation  to  Mortality  Statistics  and  the  International  List. ' ' 

377 


378         MORTALITY    STATISTICS    OF    INSURED    WAGE    EARNERS. 


TABLE  178. 

EFFECT  or  SYSTEM  or  INQUIRY  TO  PHYSICIANS  UPON  DEATH  BATES  OF  IM- 
PORTANT DISEASES  AND  CONDITIONS. 
Number  of  Deaths  before  and  after  Inquiry  and  Percentage  Change  in 

Death  rate. 

Experience  of  Metropolitan  Life  Insurance  Company.     Industrial  Depart- 
ment.    1911  to  1916. 


Infl  List 
Number. 

Disease  or  Condition. 

Number  of 
Deaths. 

Percentage, 
Deaths  After 
of  Deaths 
Before 
Inquiry. 

Before 
Inquiry. 

After 
Inquiry. 

185 
66 
117 
67 
B61 
46 

62 
119 
186 
94 
20 
45 

92 
120 
28 
9 
156-163 
29,  32-35 
40 

1 
155 
39 

81 

8 
7 
31 
41 

6 
108 
42 

182 
43 

44 

64 
183-184 

Fractures  (cause  not  specified)  

2280 
5052 
1725 
3341 
6010 

402 
1091 
6500 
2148 
1082 
1239 

5800 
45084 
52260 
93351 
13052 
6518 
8981 

13957 
8882 
2310 

1324 

8899 
2995 
4505 
3054 

4338 
4619 
6118 

7588 
2334 

3418 

894 
34443 
1237 

806 
2773 
1013 
2224 
4171 

293 
797 
5120 
1722 
939 
1083 

5279 
41707 
52067 
93526 
13089 
6542 
9035 

14153 
9011 
2352 

1353 

9142 
3075 
4638 
3155 

4482 
4776 
6345 

7882 
2435 

3579 

938 
36638 
1318 

35.4 
54.9 
58.7 
66.6 
69.4 

72.9 
73.1 

78.8 
80.2 
86.8 
87.4 

91.0 
92.5 
99.6 
100.2 
100.3 
100.4 
100.6 

101.4 
101.5 
101.8 

102.2 

102.7 
102.7 
103.0 
103.3 

103.3 
103.4 
103.7 

103.9 
104.3 

104.7 

104.9 
106.4 
106.5 

Paralysis  without  specified  cause  

Simple  peritonitis  —  nonpuerperal  

General  paralysis  of  the  insane  

Simple  meningitis  

Other  tumors  (tumors  of  the  female  genital 
organs  excepted)  

Locomotor  ataxia  

Acute  nephritis  

Other  external  violence  (excl.  war  deaths)  .  . 
Pulmonary  congestion,  pulmonary  apoplexy 
Purulent  infection  and  septicemia  

Cancer  and  other  malignant  tumors  of  other 
organs  or  of  organs  not  specified  

Pneumonia  (lobar  and  undefined)  

Bright's  disease  

Tuberculosis  of  the  lungs  

Diphtheria  and  croup    ..            

Suicides  (except  suicide  by  poison)   

Other  forms  of  tuberculosis  

Cancer  and  other  malignant  tumors  of  the 
stomach  

Typhoid  fever      

Suicide  by  poison     

Cancer  and  other  malignant  tumors  of  the 
buccal  cavity  

Diseases  of  the  arteries,  atheroma,  aneur- 
ism, etc  

Whooping  cough  

Scarlet  fever                     

Abdominal  tuberculosis  

Cancer  and  other  malignant  tumors  of  the 
peritoneum,  intestines,  rectum  

Measles      

Appendicitis  and  typhlitis  

Cancer  and  other  malignant  tumors  of  the 
female  genital  organs  

Homicide  by  firearms  

Cancer  and  other  malignant  tumors  of  the 
breast  

Cancer  and  other  malignant  tumors  of  the 
skin  

Cerebral  hemorrhage,  apoplexy  

Homicide  (except  homicide  by  firearms)  .  .  . 

APPENDIX   C. 


TABLE  178  (Continued). 


379 


Int'l  List 
Number. 

Disease  or  Condition. 

Number  of 
Deaths. 

Percentage, 
Deaths  After 
of  Deaths 
Before 
Inquiry. 

Before 
Inquiry. 

After 
Inquiry. 

91 
B63 
10 
30 
51 
56 
172 
37 
38 
A61 

Bronchopneumonia    

15126 
1945 
7247 
4129 
629 
2124 
5558 
2345 
83 
290 

16224 
2160 
8056 
4647 
743 
2555 
6917 
4659 
200 
823 

107.3 
111.1 
111.2 
112.5 
118.1 
120.3 
124.4 
198.7 
241.0 
283.8 

Other  diseases  of  the  spinal  cord  

Influenza    

Tuberculous  meningitis  

Exophthalmic  goitre  

Alcoholism  (acute  or  chronic)  

Traumatism  by  fall  

Syphilis        .          

Gonococcus  infection  

Cerebrospinal  fever  

of  error  in  mortality  statistics  of  the  several  diseases  and  condi- 
tions. The  remedy  for  the  first  cause  of  error  lies  largely  with  the 
forces  of  medical  education  and  diagnostic  progress.  The  amount 
of  absolute  error  due  to  the  second  important  element  of  incom- 
plete statement  can  be  quite  readily  controlled  by  a  system  of  cor- 
respondence with  certifying  physicians.  By  means  of  such  a  pro- 
gramme, each  certification  by  a  physician  which  is  obviously  or 
probably  an  understatement  is  subjected  to  scrutiny  and  becomes 
the  occasion  for  a  letter  asking  for  all  the  facts  as  to  diseases  and 
conditions  contributing  to  the  death. 

A  plan  of  this  kind  was  inaugurated  at  the  beginning  of  the 
present  mortality  investigation  and  was  carried  out  in  principle, 
with  necessary  additions  in  the  scope  of  the  inquiries,  throughout 
the  entire  six-year  period.  In  Table  178  on  pages  378  and  379,  we 
show  the  effect  of  this  system  of  correspondence  upon  the  death 
rates  of  the  more  important  diseases  and  conditions  represented  in 
this  experience. 

From  the  foregoing  tabulation,  it  will  be  seen  that  as  a  result 
of  correspondence  with  physicians  the  number  of  deaths  certified 
as  due  to  "fractures"  (cause  not  specified)  was  reduced  from 
2,280  before  inquiry  to  806  after  inquiry,  or  a  reduction  of  64.6 
per  cent.  Another  equally  unsatisfactory  certification  was  "  paraly- 
sis," without  specified  cause.  The  number  of  such  registrations 
in  our  final  tables  was  reduced  from  5,052,  the  number  which  was 
originally  reported  by  physicians,  to  2,773,  after  inquiry,  or  a  re- 
duction of  45.1  per  cent.  Inspection  of  the  table  will  show  other 
important  alterations  in  the  death  rates  of  certain  causes  of  death, 


380         MORTALITY    STATISTICS    OP    INSURED    WAGE    EARNERS. 

the  reduction  being  due  solely  to  the  persistent  scrutiny  of  death 
certificates  for  incomplete  statements,  and  the  subsequent  effort  to 
secure  complete  and  satisfactory  reports  from  the  physicians.  A 
number  of  causes  of  death  such  as  Bright's  disease,  tuberculosis 
of  the  lungs,  diphtheria  and  croup,  cancer  of  the  stomach,  and 
typhoid  fever  were  affected,  so  far  as  their  death  rates  were  con- 
cerned, only  to  a  very  limited  extent  by  this  system  of  inquiry. 
Certain  other  causes  of  death  such  as  whooping  cough,  scarlet  fever 
and  cancer  of  the  peritoneum,  intestines  and  rectum,  which  one 
might  expect  to  be  affected  by  masked  returns  of  "broncho- 
pneumonia,"  "acute  nephritis"  and  "peritonitis,"  respectively, 
show  sbmewhat  greater  percentages  of  -alteration  in  the  recorded 
death  rates.  Cerebral  hemorrhage  and  apoplexy,  influenza,  alcohol- 
ism, traumatism  by  fall,  syphilis,  gonococcus  infection  and  cerebro- 
spinal  fever  were  quite  emphatically  influenced  in  their  death  rates 
by  this  programme  of  correspondence  with  certifying  physicians. 

The  table  on  pages  381  to  384  shows  what  disposition  was  made 
of  certain  of  the  terms  originally  certified  under  obviously  incom- 
plete statements. 

Thus,  out  of  295  "purulent  infection  and  septicemia,"  replies 
received,  most  of  which  were  originally  returned  as  "  septicemia," 
76  cases  or  25.8  per  cent,  were  finally  classified  in  our  statistics  as 
"  puerperal  septicemia."  Cancer  cases,  where  the  organ  or  part 
was  not  specified  by  the  physician,  in  223  cases,  or  25.3  per  cent., 
out  of  an  original  total  of  883  replies,  were  subsequently  registered 
as  "cancer  of  the  female  genital  organs,"  and  126  cases,  or  14.3 
per  cent,  as  "  cancer  of  the  breast." 

Returns  of  "  meningitis  "  were  found  to  have  been  due  to  tuber- 
culous meningitis  in  17.1  per  cent,  of  the  cases  and  to  cerebrospinal 
fever  in  19.1  per  cent,  of  the  total  number  of  replies  received. 
Terminal  cardiac  states  such  as  "acute  cardiac  dilatation"  and 
"cardiac  insufficiency"  were  found  to  have  been  pneumonia  cases 
in  11.9  per  cent,  of  the  replies  received.  "Peritonitis"  without 
further  definition  was  finally  registered  as  "  appendicitis  "  in  17.3 
per  cent,  of  the  cases  and  as  "  puerperal  septicemia  "  in  14  per  cent. 

The  statistics  of  accidental,  homicidal  and  suicidal  violence  were 
affected  in  an  important  degree  by  the  clearing  up  process  applied 
to  cases  which  were  simply  certified  as  "  fractures."  Out  of  1,637 
fracture  cases,  1,011,  or  61.8  per  cent,  of  the  total  number,  were 


APPENDIX   C. 


TABLE  179. 


381 


NUMBEB  OF  DEATHS  WHERE  THE  CAUSES  OF  DEATH  WERE  ORIGINALLY  SPECI- 
FIED IN  ILL-DEFINED  TEEMS,  SHOWING  ALSO  THE  NUMBER  AND  PER- 
CENTAGE OF  SUCH  DEATHS  DEFINITELY  CERTIFIED   AFTER 
INQUIRY  TO  PHYSICIANS. 

Experience  of  Metropolitan   Life   Insurance   Company.     Industrial   Depart- 
ment.    1911  to  1916. 


Ill-defined  Term  Reported 
Before  Inquiry  to  Physician. 

Cause  of  Death  Ascertained  by  Inquiry  to 
Physician. 

Changes  In  State- 
ment of  Cause 
of  Death. 

Num- 
ber. 

Percent- 
age 

Purulent  infection  and 
septicemia 
Total  replies  —  295 
Unchanged  by  inquiry  : 
88  or  29.8  percent. 

Cancer  and  other  ma- 
lignant      tumors      of 
other  organs,  or  of  or- 
gans not  specified 
Total  replies  —  883 
Unchanged  by  inquiry  : 
246  or  27.9  percent. 

Meningitis 
Total  replies  —  2560 
Unchanged  by  inquiry  : 
701  or  27.4  percent. 

Locomotor  ataxia       ) 
Total  replies—  596 
Unchanged  by  inquiry  :  [ 
294  or  49.3  percent.    J 

Paralysis  without  speci- 
fied cause 
Total  replies  —  2598 
Unchanged  by  inquiry  : 
302  or  11.6  percent. 

Total  changes  from  "purulent  infection 
and    septicemia"    to    cause   of    death 
specified  below  

207 

70.2 

"Other  diseases  of  the  uterus"  

8 
76 
9 
114 

637 

2.7 
25.8 
3.1 
38.6 

72.1 

Puerperal  septicemia  

Acute  abscess  

Other  titles  

Total  changes  from  "cancer.  .  .,  organs 
not  specified"  to  cause  of  death  speci- 
fied below  ....              .    .        ... 

Cancer.  .  .of  the  buccal  cavity  

27 
113 

100 
223 
126 
42 
6 

1859 

3.1 

12.8 

11.3 
25.3 
14.3 
4.8 

.7 

72.6 

Cancer  ...  of  the  stomach  

Cancer  ...  of  the  peritoneum,  intestines, 
rectum  

Cancer.  .  .of  the  female  genital  organs.  . 
Cancer  ...  of  the  breast  

Cancer  ...  of  the  skin  

Other  titles  

Total    changes   from    "meningitis"    to 
cause  of  death  specified  below  

Tuberculous  meningitis  

439 
489 
108 
94 
729 

302 

17.1 
19.1 
4.2 
3.7 
28.5 

50.7 

Cerebrospinal  fever  

Pneumonia  —  lobar  and  undefined  

Diarrhea  and  enteritis  —  2  years  and  over 
Other  titles  

Total  changes  from  "locomotor  ataxia" 
to  cause  of  death  specified  below       .  . 

Syphilis  „  

282 
20 

2296 

47.3 
3.4 

88.4 

Other  titles  

Total  changes  from  "paralysis  without 
specified    cause"    to    cause    of    death 
specified  below  

"Other  diseases  of  the  spinal  cord".  .  .  . 
Cerebral  hemorrhage,  apoplexy  

322 
1613 
149 
212 

12.4 
62.1 
5.7 

8.2 

General  paralysis  of  the  insane  

Other  titles  

382 


MORTALITY    STATISTICS    OF    INSURED    WAGE    EARNERS. 


TABLE  179  (Continued). 


ni-deflned  Term  Reported 
Before  Inquiry  to  Physician. 

C»UM  of  Death  Ascertained  by  Inquiry  to 
Physician. 

Change*  In  State- 
ment ol  Cause 
of  Death. 

Num- 
ber. 

I'erceut- 
age. 

General  paralysis  of  the 
insane 
Total  replies  —  2076 
Unchanged  by  inquiry: 
761  or  36.7  percent. 

Organic  diseases  of  the 
heart* 
Total  replies  —  1175 
Unchanged  by  inquiry  : 
697  or  59.3  percent. 

Diseases  of  the  arteries, 
atheroma,     aneurism, 
etc.f 
Total  replies  —  953 
Unchanged  by  inquiry: 
493  or  51.7  percent. 

Pneumonia 
Total  replies  —  5493 
Unchanged  by  inquiry  : 
1595  or  29.0  percent. 

Pulmonary  congestion, 
pulmonary  apoplexy 
Total  replies  —  245 
Unchanged  by  inquiry: 
84  or  34.3  percent. 

Peritonitis  —  non-puer- 
peral 
Total  replies  —  901 
Unchanged  by  inquiry  : 
179  or  19.9  percent. 

Total  changes  from  "general  paralysis 
of    the    insane"    to    cause    of    death 
specified  below  

1315 

63.3 

Syphilis  

1257 
58 

478 

60.5 
2.8 

40.7 

Other  titles  

Total  changes  from  "organic  diseases  of 
the  heart"  to  cause  of  death  specified 
below  

Cerebral  hemorrhage,  apoplexy  

86 
140 
252 

460 

7.3 

11.9 
21.4 

48.3 

Pneumonia  —  lobar  and  undefined  

Other  titles  

Total  changes  from  "diseases  of  arteries, 
etc."  to  cause  of  death  specified  below  . 
Syphilis  

175 
172 
113 

3898 

18.4 
18.0 
11.9 

71.0 

Cerebral  hemorrhage,  apoplexy  

Other  titles  

Total   changes  from   "pneumonia"   to 
cause  of  death  specified  below  

Influenza  

529 
1076 
1692 
601 

161 

9.6 
19.6 
30.8 
10.9 

65.7 

Bronchopneumonia  

Lobar  pneumonia  

Other  titles  

Total  changes  from  "pulmonary  conges- 
tion, pulmonary  apoplexy"  to  cause  of 
death  specified  below  

Organic  diseases  of  the  heart  

32 
8 
16 
11 
94 

722 

13.1 
3.3 
6.5 
4.5 
38.4 

80.1 

Chronic  bronchitis  

Pneumonia  —  lobar  and  undefined  

Bright's  disease  

Other  titles  

Total    changes    from    "peritonitis"    to 
cause  of  death  specified  below  

Abdominal  tuberculosis  

69 
33 
156 

76 
126 
262 

7.7 
3.7 
17.3 

8.4 
14.0 
29.1 

Diarrhea  and  enteritis  —  2  years  and  over 
Appendicitis  and  typhlitis  

Salpingitis  and  other  diseases  of  the  fe- 
male genital  organs  

Puerperal  septicemia  

Other  titles  

*  Most  of  the  terms  included  under  the  title  ' '  organic  diseases  of  the 
heart"  are  fairly  definite.  However,  certain  expressions  such  as  "acute 
cardiac  dilatation"  and  "cardiac  insufficiency"  are  often  reported  when 
they  are  only  terminal  symptoms  of  other  diseases.  It  is  these  expressions 
which  are  covered  by  our  inquiry. 

t  Practically  all  of  the  inquiries  related  to  reports  of  ' '  aneurism, ' ' 


APPENDIX   C. 


383 


TABLE  179  (Continued). 


Ill-defined  Term  Reported 
Before  Inquiry  to  Physician. 

Cause  of  Death  Ascertained  by  Inquiry  to 
Physician. 

Changes  In  State- 
ment of  Cause 
of  Death. 

Num- 
ber. 

Percent- 
age. 

Acute  nephritis 
Total  replies  —  3271 
Unchanged  by  inquiry: 
1852  or  56.6  percent. 

"Other  diseases  of  the 
uterus  '  ' 
Total  replies  —  280 
Unchanged  by  inquiry: 
85  or  30.4  percent. 

Traumatism     by     fire- 
arms 
Total  replies  —  157 
Unchanged  by  inquiry  : 
35  or  22.3  percent. 

Fractures     (cause     not 
specified) 
Total  replies  —  1637 
Unchanged  by  inquiry  : 
151  or  9.2  percent. 

"Other    external    vio- 
lence" 
Total  replies  —  708 
Unchanged  by  inquiry: 
132  or  18.6  percent. 

Total  changes  from  "acute  nephritis" 
to  cause  of  death  specified  below  

1419 

43.4 

Scarlet  fever  

95 
156 
341 
118 
709 

195 

2.9 
4.8 
10.4 
3.6 
21.7 

69.6 

Influenza  

Alcoholism  (acute  or  chronic)  

Bright's  disease  

Other  titles  

Total  changes  from  "other  diseases  of 
the  uterus"  to  cause  of  death  specified 
below  

Gonococcus  infection  

23 

12 
25 
6 

38 
53 
38 

122 

8.2 

4.3 
8.9 
2.1 

13.6 
18.9 
13.6 

77.7 

Cancer  and  other  malignant  tumors  of 
the  female  genital  organs  

Uterine  tumor  (noncancerous)  

Cysts  and  other  tumors  of  the  ovary.  .  . 
Salpingitis  and  other  diseases  of  the  fe- 
male genital  organs  

Puerperal  septicemia  

Other  titles  

Total  changes  from  traumatism  by  fire- 
arms to  cause  of  death  specified  below  . 
Suicide  by  firearms  

9 
110 
3 

1486 

5.7 
70.1 
1.9 

90.8 

Homicide  by  firearms  

Other  titles  

Total  changes  from  "fractures   (cause 
not  specified)  "  to  cause  of  death  speci- 
fied below  

Traumatism  by  fall  

1011 
53 

44 
61 
89 
60 
168 

576 

61.8 
3.2 

2.7 
3.7 
5.4 
3.7 
10.3 

81.4 

Traumatism  by  crushing  —  electric  rail- 
way   

Traumatism  by  crushing  —  steam  rail- 
way   

Traumatism  by  crushing  —  automobiles. 
Traumatism  by  crushing  —  other  vehicles 
Traumatism  by  other  means  

Other  titles  

Total    changes    from    "other    external 
violence"  to  cause  of  death  specified 
below  

Purulent  infection  and  septicemia  

22 
218 
41 

43 

21 
26 
58 
147 

3.1 
30.8 
5.8 

6.1 

3.0 
3.7 

8.2 
20.8 

Traumatism  by  fall  

Traumatism  by  machines   

Traumatism  by  crushing  —  steam  rail- 
way   

Traumatism  by  crushing  —  electric  rail- 
way   

Traumatism  by  crushing  —  automobiles  . 
Traumatism  by  crushing  —  other  vehicles 
Other  titles  

384          MORTALITY    STATISTICS    OF    INSURED    WAGE    EARNERS. 


TABLE  179  (Continued). 


Ill-defined  Term  Reported 
Before  Inquiry  to  I'tiysli  um. 

Cause  of  Death  Ascertained  by  Inquiry  to 
Pbyslclan. 

Changes  |D  State- 
ment of  Cause 
of  Death. 

Num- 
ber. 

Per  Of  Dt<- 

•**. 

Ill-defined  diseases 
Total  replies—  598 
Unchanged  by  inquiry  : 
176  or  29.4  percent. 

Total    changes    from    "ill-defined    dis- 
eases" to  cause  of  death  specified  below 

Malaria  

422 

70.6 

15 
22 
107 
27 
251 

2.5 
3.7 
17.9 
4.5 
42.0 

Tuberculosis  of  the  lungs  

Organic  diseases  of  the  heart  

Bright's  disease  

Other  titles  

identified  as  deaths  due  to  falling;  3.2  per  cent,  were  caused  by 
electric  railway  accidents,  2.7  per  cent,  by  steam  railway  accidents, 
3.7  per  cent,  by  automobile  accidents  and  5.4  per  cent,  by  other 
vehicular  accidents.  "Gunshot  wound,"  in  157  replies,  was  found 
to  have  been  homicide  by  firearms  in  110  cases,  or  70.1  per  cent., 
and  suicide  by  firearms  in  9  cases,  or  5.7  per  cent.  Original  certi- 
fications of  "  injury,"  "  violent  death,"  and  other  ill  defined  terms 
for  violence  classified  under  Title  186  of  the  International  List, 
were  found  to  have  been  made  for  falls  in  30.8  per  cent,  of  the 
cases ;  in  machinery  accidents  in  5.8  per  cent. ;  in  steam  railway 
accidents  in  6.1  per  cent,  of  the  original  number  of  returns. 

From  this  brief  review  of  an  extensive  programme  for  improv- 
ing the  validity  of  the  statistics  of  the  causes  of  death  shown  in 
this  present  report,  it  will  be  seen  that  incomplete  and  understate- 
ment of  the  morbid  conditions  contributing  to  death  is  highly 
significant  to  students  of  the  medical  statistics  of  mortality.  It  is 
evident  that  some  allowance  must  be  made  in  all  published  statistics 
of  mortality  from  causes  of  death,  for  this  factor  of  possible  under 
and  incomplete  certification  of  diseases  and  conditions.  The  fore- 
going tables  and  the  appended  text  will  show  in  a  measure  the 
extent  of  this  specialized  problem  in  medical  statistics.  It  is  hoped 
that  the  value  of  a  systematic  programme  of  inquiry  to  physicians 
in  cases  of  doubtful  certification  has  been  established  by  the  fore- 
going display  of  the  facts  for  the  basic  material  of  this  report. 
They  supplement  the  conclusions  published  in  recent  Census  Bu- 
reau mortality  reports  under  the  caption  of  "  Accuracy  of  Statistics 
of  Causes  of  Death." 


APPENDIX  D. 
STANDARDIZED,  OR  CORRECTED,  DEATH  RATES. 

A  judgment  on  the  comparative  healthfulness  of  two  popula- 
tion or  exposure  groups,  in  terms  of  a  single  expression,  is  often 
necessary  in  the  analysis  of  public  health  statistics.  For  instance, 
we  may  wish  to  compare,  in  the  aggregate,  white  males  of  the  in- 
surance experience  with  males  of  the  Registration  Area  experi- 
ence. No  direct  comparison  of  the  death  rates  for  the  total,  ages 
one  and  over,  is  valid,  however,  without  proper  allowance  for  dif- 
ferences in  the  age  composition  of  the  two  groups.  On  page  23 
we  gave  a  comparison  of  the  death  rates  of  the  insurance  and!  popu- 
lation groups,  and  showed  that  for  all  ages  one  and  over,  insured 
white  males  had  a  crude  mortality  rate  95.2  per  cent,  of  the  rate 
among  males  in  the  general  population,  and  that  insured  white 
females  registered  a  death  rate  93.9  per  cent,  of  the  rates  for 
females  in  the  population  of  the  expanding  Registration  Area  of 
the  United  States.  Apparently,  there  was  a  more  favorable  bal- 
ance of  mortality  for  the  group  of  insured  wage  earners.  But  in- 
spection of  the  table  on  page  5  shows  that  the  average  age  of  the 
insured  group  is  much  lower  than  that  of  the  population  exposure. 
A  considerable  bulk  of  the  insurance  white  male  experience  con- 
sists of  lives  under  twenty  years  of  age  (50.3  per  cent.),  as  com- 
pared with  36.2  per  cent,  in  the  population  experience.  These  dif- 
ferences in  age  constitution  account  for  the  apparently  more  favor- 
able ratio  of  mortality  in  the  total  white  male  and  white  female 
insured  groups. 

A  convenient  means  for  eliminating  the  influence  of  variable 
age  constitution  is  available.  The  "  specific  death  rates,"  or  death 
rates  relating  to  specific  sex  and  age  classes  in  the  two  groups  to 
be  compared,  can  be  multiplied  into  an  assumed  "  standard  popu- 
lation" by  sex  and  age  to  produce  an  "expected"  number  of 
deaths.  For  this  purpose  we  chose  the  age  groups  (for  ages  one 
and  over)  of  the  "standard  million  of  population,  England  and 
Wales,  1901,"  and  by  multiplying  the  sex  and  age  death  rates  of 

385 


386         MORTALITY    STATISTICS    OP    INSURED   WAGE    EARNERS. 


the  insurance  and  population  experiences,  respectively,  into  the 
numbers  in  each  of  the  corresponding  sex  and  age  classes  of  the 
"standard"  or  "norm"  population,  we  produced  for  each  experi- 
ence and  sex  class,  an  "expected  total  number  of  deaths."  The 
ratio  of  the  expected  number  of  deaths  based  upon  the  rates  for 
insured  white  males  to  the  expected  number  of  deaths  for  popula- 
tion males,  is  an  accurate  measure  of  the  relative  healthfulness  of 
the  two  groups,  so  far  as  we  may  determine  this  fact  from  the  mor- 
tality statistics  of  the  two  groups.  A  tabular  display  of  the  results 
of  this  correction  process  is  given  below : 

TABLE  180. 

EXPECTED  NUMBEB  OF  DEATHS,  AGES  ONE  AND  OVER,  IN  ' '  STANDAED  MILLION 
OF  POPULATION  IN  ENGLAND  AND  WALES,  1901"  ACCORDING  TO  SPECIFIC 
DEATH  RATES  OF  (a)  METROPOLITAN  INDUSTRIAL  WHITE  EXPERIENCE, 
1911  TO  1916  AND  (&)  EXPANDING  REGISTRATION  AREA  EXPERIENCE,  1910 
TO  1915,  BY  SEX. 


Sex. 

Expected  Number  of  Deaths  In  "Stand- 
ard Population,"  According  to  Specific 
Death  Rates  In  : 

Percentage.  M.  1..  I. 
Co.  of  Reg.  Area 

Expected  Deaths. 

M.  L.  I.  Co.  White 
Experience.  1911 
to  1916. 

Reg.  Area  (U.  8.) 
Experience.  1910 
to  1915. 

Males  

7,107 
6,264 

5,561 
5,602 

127.8 
111.8 

Females  

From  the  foregoing  table  we  may  conclude  that  the  total  mor- 
tality of  insured  white  male  wage  earners  is  in  reality  28  per  cent, 
higher  than  mortality  among  males  in  the  general  population  and 
that  the  group  of  insured  white  females  shows  an  excess  of  12  per 
cent,  in  mortality. 

If  the  numbers  of  expected  deaths  in  the  foregoing  table  are 
divided  by  the  total  corresponding  "  standard  population  "  at  ages 
one  and  over  the  following  "corrected"  death  rates  are  produced. 
A  comparison  with  the  crude  rates  is  shown  in  the  table  on  page 
387,  together  with  the  standardization  or  correction  factor. 

In  other  words,  the  process  of  correction  produces  an  increase 
of  27.7  per  cent,  in  the  death  rate  for  insured  white  males,  of  19.5 
per  cent,  in  the  death  rate  of  insured  white  females,  a  decrease  of 
4.8  per  cent.,  and  an  increase  of  .3  per  cent,  in  the  death  rates 
of  males  and  females,  respectively,  in  the  general  population. 


APPENDIX   D. 


387 


TABLE  181. 
CRUDE  AND  STANDARDIZED  DEATH  RATES  PER  1,000,  ALL  CAUSES  OF  DEATH, 

COMPARED. 
Standardization  factor:   (Eatio  of  Standardized  to  Crude  Rate). 


Experience  Group;  Sex. 

Crude  Rate. 

Standardized 
Rate. 

Factor. 

Metropolitan  Ind.  White  Experience, 
1911  to  1916. 
Males  

11.82 

15.09 

1.277 

Females  

10.40 

12.43 

1.195 

Registration  Area  Experience,  1910  to 
1915. 
Males  

12.41 

11.81 

.952 

Females  

11.08 

11.11 

1.003 

INDEX. 


Abdominal  tuberculosis,  62 
—  ,  and  "dysentery,"  265 

Abortions  and  miscarriages,  203 

Absorption  of  deleterious  gases,  119 

Accidental  drowning,   104 

Accidental  poisoning,  117 

Accident  death  rate,  improving,  125 

Accident  problem  in  the  United 
States,  and  in  England  and  Wales, 
94 

Accidents,  94 

-  ,  according  to  means  of  injury, 
100 

Accidents  of  labor,  204 

-  ,  decline  in  mortality,  210 

-  ,  prenatal  nursing  in  prevention 
of,   210 

Accidents  of  pregnancy,  203 
Accuracy  of  certified  causes  of  death, 
30,  377 

-  ,  increasing     deathrates     from 
"  degenerative  diseases,"  70 

-  communicable  diseases  of  child- 


hood, 188 

Acute  accidental  poisonings,  117 
Acute  articular  rheumatism,  242 
Acute  bronchitis,  245 

—  ,  in  children,  245 
Acute  endocarditis,  275 
Acute  nephritis,  283 

-  ,  following   infectious    diseases, 
283 

-  ,  and    scarlet    fever    mortality, 
185 

Acute  poliomyelitis,  262 
Adolescence,  suicide  in,  131 
Adolescent  women  and  suicide,  131 
After-mortality  of  typhoid  fever,  222 
Age   composition   of  insured   group, 

comparison    with    United    States 

Eegistration  Area,  5 


Ages,    mortality    by,    from    certain 
diseases — see  particular  disease 

Albuminuria,       during      pregnancy, 
childbirth  and  the  puerperium,  199 

Albuminuria  in  the  maternal  state, 
202 

Alcoholism,  246 

,  and  cirrhosis  of  the  liver,  223 

— — ,  defective   and   unreliable    sta- 
tistics, 223,  248 

All     causes    of    death,    number    of 
deaths  or  death  rates-  by  color,  sex 
or  age,  11,  13,  14,  34,  304 
— ,  in  1917,  293 

— ,  1911  to  1916,  by  single  calen- 
dar years,  366 

Anemia,  267 

— ,  chlorosis,  267 

Aneurism,  215 

,  and  syphilis,  238 

Angina  pectoris,  260 

Anterior  poliomyelitis,  262 

Antitoxin  in  diphtheria,  191 

Appalachian  Plateau,  malaria  in  the, 
257 

,  pellagra  in  the,  249 

Appendicitis,  233 

Areas  included  in  this  study,  2 

Arteries,  diseases  of  the,  215 

Arteriosclerosis,  215 

,  and    softening    of   the    brain, 


271 


as     ' '  degenerative     disease, ' 


216 

Arthritis  deformans,  242 
Asphyxiation,   accidental,   119 

,  suicidal,  136 

Asthma,  278 

Atheroma,  215 

Atlanta,  Ga.,  pellagra  in,  250 

Augusta,  Ga.,  pellagra  in,  250 

.  malaria  in  256 


389 


390 


INDEX. 


Automobile  accidents  and  injuries, 
increasing  death  rate,  109 

Biliary  calculi,  281 

Birmingham,  Ala.,  pellagra  in,  250 

,  malaria  in,  256 

Birthrate  in  relation  to  maternal 
mortality,  201 

Bladder,  cancer  of  the,  171 

,  abscess  of  the,  285 

,  diseases  of  the,  285 

Boston,  Mass.,  prenatal  nursing  in, 
213 

Bright 's  disease,  87 

,  and  car dio- vascular  disease,  87 

,  classification  difficulties  in,  87 

— — ,  increasing  deathrate  from,  91 

Bronchial  asthma,  278 

Bronchitis,  acute,  245 

Bronchitis,  chronic,  241 

Bronchopneumonia,  78 

,  as  unsatisfactory  statement  of 

cause  of  death,  30,  379 

,  reliability  of  mortality  sta- 
tistics of,  86 

Brownlee,  John,  51 

Buccal  cavity,  cancer  of  the,  170 

Burns,  106 

Csesarean  section,  204 

Cairo,  111.,  malaria  in,  256 

Calculus,  biliary,  281 

Campaign  against  tuberculosis,  59 

Cancer,     problem     in     the     United 

States,  147 
,  by  organs  or  parts,  148 

-        » 

stomach  and  liver,  160 
female  genital  organs,  163 
breast,  165 
peritoneum,    intestines,    rectum, 

168 

buccal  cavity,  170 
skin,  170 

male  genital  organs,  171 
,  in   relation   to   economic    con- 
dition or  social  status,  155 


Cancer,  continued 

,  increasing)  mortality  rates 

from,  156 

,  increasing  mortality  in  cer- 
tain age  periods,  159 

,  and  tuberculosis  of  abdom- 
inal organs,  in  relation  to  child- 
bearing,  168 

Cardiac   disease — see   Heart   disease 

,  ill-defined,  290 

Cardio-vascular-renal  disease  and 
cerebral  hemorrhage,  173 

Cardio-vascular-renal  diseases— see 
Heart  disease,  Bright 's  disease, 
Cerebral  hemorrhage  and  apo- 
plexy, 65,  87,  173 

Causes  of  death,  improved  state- 
ments of,  377 

Cerebral  hemorrhage  and  apoplexy, 
173 

Cerebral  softening,  271 

Cerebral  tumor,  273 

,  and  syphilis,  238 

Cerebrospinal  fever,  269 

Cerebrospinal  meningitis,  268 

Certification,  of  diseases  causing 
death,  264 

,  of  cerebral  hemorrhage,  173 

,  of  alcoholism,  248 

,  improvement  in,  by  system  of 

inquiry,  377 

Changes  in  deathrates,  following  in- 
quiry to  physicians,  377 

Charlotte,  N.  C.,  pellagra  in,  250 

,  malaria  in,  256 

Chattanooga,  Tenn.,  pellagra  in,  250 

Child-bearing  in  relation  to  cancer 
and  tuberculosis  of  the  abdominal 
organs,  168 

Childbirth,  mortality  in,  197,  213 

Children,  in  wage  earners'  families, 
mortality  of,  3 

,  under  one  year  of  age,  7 

,  automobile  accidents  among, 

110 

,  communicable  diseases  of,  178 

,  diarrhea  and  enteritis  in,  193 

,  convulsions  in,  273 


INDEX. 


391 


Chlorosis,  26Z 

Cholelithiasis,  282 

Chronic  bronchitis,  241 

,  and  certification  of  tubercu- 
losis, 242 

Chronic  pneumonia,  279 

Chronic  poisonings,  267 

Chronic  recurrent  pellagra,  255 

Cirrhosis  of  the  liver,  223 

Classification  of  causes  of  death,  9, 
32 

Classification  procedure  in  relation  to 
increased  deathrate  from  ' '  degene- 
rative diseases, ' '  70 

Coastal  plain  of  the  South,  malaria 
in  the,  257 
— ,  pellagra  in  the,  249 

Cocainism,  267 

Codification  processes,  9 

Color  or  race  composition  of  insured 
group,  4 

Colored  males  and  females,  by 
causes  of  death,  see  Eacial  mor- 
tality 

Columbia,  S.  C.,  pellagra  in,  250 

,  malaria  in,  256 

Columbus,  Ga.,  pellagra  in,  250 

,  malaria  in,  256 

"Confinement,"  deaths  in,  204 

Convulsions,  273 

,  puerperal,  202 

,  in  children,  273 

Corrected  deathrates,  385 

Correspondence  with  physicians  to  in- 
crease accuracy  of  certified  causes 
of  death,  30,  377 

Cystitis,  285 

Deaths,  by  color,  sex  or  age,  11,  12, 
34,  304;  by  single  years,  366 

Deathrates — see  entries  for  each 
cause  of  death 

,  by  single  calendar  years,  1911 

to  1916,  and  by  causes  of  death, 
366 ;  by  color  and  sex,  34 

"Debility,"  290 

"Degenerative  diseases" — see  Heart 
disease,  Bright 's  disease,  Cerebral 


hemorrhage  and  apoplexy,  65,  87, 
173 

Dementia  paralytica,  272 

Dementia  precox  and  suicide  in  ado- 
lescence, 131 

Diabetes  mellitus,  229 

,  relation  to  working  conditions, 

229 

,  and  menopause,  230 

,  increasing  deathrate  from,  232 

Diarrhea  and  enteritis,  193 

,  and  "dysentery,"  265 

Diet  in  causation  of  pellagra,  '254 

Diphtheria,  189 

Disability  among  Southern  wage 
earners,  resulting  from  pellagra, 
250 

Diseases  of  the  arteries,  215 

Diseases  of  intestines,  193 

Disseminated  tuberculosis,  64 

"Drink  habit,"  statistics  of,  248 

"Dropsy,"  290 

Drowning,  accidental,  104 

,  suicidal,  137 

Drunkenness,  mortality  from,  248 

Dublin,  Louis  I.,  155,  175,  185,  222 

"Dysentery,"  264 

Ears,  diseases  of  the,  274 
Eastland  disaster,  Chicago,  HI.,  1915, 

105 

Eclampsia,  puerperal,  202 
Economic  aspects  of  homicide,  145 
Economic  condition,  and  cancer,  155 

,  and  diabetes  mellitus,  229 

Economic  loss,  from  tuberculosis,  43 

,  from  heart  diseases,  65 

,  from     diseases    of    puerperal 

state,  197 
Economic  revival  in  the  South,  1916, 

in.  relation  to  pellagra  mortality, 

255 

Elevator  accidents,  115 
Embolism  and  thrombosis,  276 
Encephalitis,  268 
Endocarditis,  acute,  275 
Endometritis,  287 
Enteric  fever,  218 


392 


INDEX. 


Enteritis,  193 

Epidemic    cerebrospinal    meningitis, 

268 

Epidemiology  of  tuberculosis,  51 
Erysipelas,  265 
Erysipelas,  puerperal — see  puerperal 

septicemia,  201 
Estimating  number  of  policyholders 

exposed  to  risk,  8 
External  causes,  93 

— ,  classification  by,  93 

,  by  class  of  violence,  94 

Extra-uterine  gestation,  203 

Falling,  deaths  from,  102 

Fallopian  tubes,  cancer  of  the,  163 

,  diseases  of  the,  287 

Family  disintegration  and  maternal 
mortality,  213 

Fatal  accidents,  99 

Fatality  rate  of  childbirth,  213 

Fatigue,  and  diabetes  mortality,  229 

Female  genital  organs,  cancer  of  the, 
163 

,  diseases  of  the,  287 

Firearms,  accidental  deaths  from 
use  of,  121 

,  suicide  by,  138 

Floods,  mortality  from,  105 

"Follow-up  work"  of  prenatal  clin- 
ics, 213 

Forceps  delivery,  204 

Frankel,  Lee  K.,  iv 

Frequency  curves  of  tuberculosis 
mortality,  51 

Gall  stones,  282 

Gangrene,  288 

Gases,  accidental  absorption  of,  119 

"Gastritis,"  280 

Gastroenteric  tuberculosis,  62 

Gastroenteritis,  193 

General  paralysis  of  the  insane,  272 

General    paralysis    of    the    insane, 

and  syphilis,  237 
Glottis,  edema  of  the,  277 
GODOCOCCUS  infection,  266 


Gonorrhea,  266 
Gout,  242 

Great  Britain,  types  of  tuberculosis 
mortality  in,  51 

,  accident  problem  in,  94 

Greensboro,  N.  C.,  pellagra  in,  250 

Habit  poisonings,  267 
Hanging,  suicides  from,  137 
Health  conditions  of  wage  earners,  25 
Heart  disease,  among  adult  males,  65 

,  disability  resulting  from,  65 

,  burden    upon    wage    earners' 

families,  65 

-,  classification  of,  70 

,  increasing   deathrates   for,   70 

,  unsatisfactory   reports  of,   71 

"Heart  failure,"  290 

Hepatitis,  282 

Hernia,  235 

Hoffman,  Frederick  L.,  23,  156 

Homicides,  definition,  93 

,  statistics,  139 

,  problem  in  the  United  States, 

139 
Hours   of  labor,   a    factor  in   wage 

earners'  mortality,  26 
Hypostatic  pneumonia,  278 

Icterus,  282 
Ill-defined  diseases,  290 
Illuminating    gas    poisoning,     acci- 
dental, 119 
Immunity  in  negroes 
Measles,  179 
Scarlet  fever,  182 

Improvement  in  wage  earners'  mor- 
tality 
All  causes  of  death,  26 

Compared    with    Registration 

area,  27 

Tuberculosis  of  the  lungs,  55 
Abdominal  tuberculosis,  63 
Communicable  diseases  of  child- 
hood, 178 

Diarrhea  and  enteritis,  196 
Puerperal  diseases,  208 
Typhoid  fever,  222 


INDEX. 


393 


Improvement  in  wage  earners'  mor- 
tality, continued 
Pellagra,  254 
Malaria,  259 

Improvement  of  statistics  of  causes 
of  death  through  supplementary 
inquiries  to  physicians,  31,  377 

Increasing    death     rate,    for    "de- 
generative diseases,"  70 
— ,  for  lobar   pneumonia,   77 

,  for  automobile  accidents,  109 

— ,  for  diabetes  mellitus,  232 

"Indigestion,"  280 

Industrial  accidents,  115,  123 

Industrial  conditions  and  pellagra, 
249,  254 

Industrial  hazards  and  mortality,  123 

Industrial  hygiene,  a  factor  in  wage 
earners'  mortality,  26 

Industrial  insurance,  25 

Industrial  insurance  mortality  ex- 
perience as  influenced  by  visiting 
nursing,  214 

Infantile  diarrhea,  193 

Infants,  mortality  of,  7 

Infectious  diseases  of  childhood,  178 

Influenza,  226 

Inguinal  hernia,  235 

Injuries  at  birth,  204 

Inquiry  system  to  improve  certifi- 
cation of  causes  of  death,  377 

Intensity  of  labor,  a  factor  in  wage 
earners'  mortality,  26 

Intestinal  diseases,   193 

Intestinal  obstruction,  235 

Intestines,  cancer  of  the,  168 

International  List  of  Causes  of 
Death,  9,  32 

,  Number  of  deaths  classified  by 

color  and  sex  (34),  by  age  (304), 
and  by  single  calendar  years,  1911 
to  1916,  (366) 

Ireland,  tuberculosis  mortality  types 
in,  51 

Jackson,  Tenn.,  pellagra  in,  250 

— ,  malaria  in,  256 
Jaundice,  282 


Jointly  returned  causes  of  death, 
classification  of,  9,  32 

Kidneys,  cancer  of  the,  171 

,  diseases  of  the,  284 

Knight,  Augustus  S.,  155 
Knoxville,  Tenn.,  pellagra  in,  250 
Kopf,  Edwin  W.,  iv 

Labor  (in  childbirth),  mortality  dur- 
ing, 199 

Laryngismus  stridulus,  277 

Laryngitis,  277 

Larynx,  diseases  of  the,  277 

Life  conservation  resulting  from 
prenatal  work,  213 

(Life  insurance  companies,  public 
health  statistics  of,  iv 

Little  Eock,  Ark.,  pellagra  in,  250 

,  malaria  in,  256 

Liver,  abscess  of  the,  282 

,  cancer  of  the,   160 

— ,  diseases  of  the,  282 

Lobar  pneumonia,  73 

,  increasing  death  rate  from,  77 

Locomotor  ataxia,  270 

,  and  syphilis,  237 

,  Wassermann  reaction  in,  271 

Ludwig's  angina,  280 

Lues,  see  syphilis 

Macon,  Ga.,  pellagra  in,  250 

,  malaria  in,  256 

Malaria,  256 

Malaria  and  pellagra,  and  the  effi- 
ciency of  Southern  wage  earners, 
249,  254 

Male  genital  organs,  cancer  of  the, 
172 

Malignant  disease  and  anemia,  267 

Massachusetts,  malaria  in,  256 

Maternal  mortality,  197 

— ,  methods  of  studying,  197 

,  in  relation  to  age,  200 

,  prevention  of,  213 

Measles,  179 

,  immunity  in  negroes,  179 


394 


INDEX. 


Medical  selection  in  relation  to 
tuberculosis  mortality,  53 

Membranous  croup,  J89 

Memphis,  Teiin.,  pellagra  in,  250 

,  malaria  in,  256 

Meningitis,  268 

Menopause,  287 

,  in  relation  to  diabetes  mortal- 
ity in  women,  230 

Mental  diseases  in  adolescence,  131 

Michigan,  -malaria  in,  256 

Middle  Atlantic  States,  poliomyelitis 
epidemic  in,  1916,  262 

Miners'  asthma,  278,  279 

Miscarriages,  203 

Morphine  habit  poisoning,  267 

Mortality  among  wage  earners,  im- 
provement in,  26 

,  during  1917,  by  causes  of 

death,  293 

Mortality  from  occupational  causes, 
123 

Mortality  of  childhood,  185 

Mosquito  problem  and  malaria,  256 

Murder,  139 

Nashville,  Tenn.,  pellagra  in,  250 

,  malaria  in,  256 

Negroes,  cerebral  hemorrhage  certi- 
fication in  deaths  of,  175 

,  immunity   among 

from  measles,  179 
from  scarlet  fever,  182 

,  higher  typhoid  fever  death- 
rate  among,  219 

,  and  pellagra,  249 

,  deathrates  among,  see  Racial 

mortality 

Negro  women,  and  puerperal  mortal- 
ity, 199 

,  illegitimacy  a  factor  in  ma- 
ternal deathrate  of,  201 

,  puerperal  hemorrhage  in  older, 

204 

Nervous  system,  diseases  of  the,  273 

Neurasthenia,  273 

Newark,  N.  J.,  poliomyelitis  epi- 
demic in,  1916,  263 


New  England  States,  poliomyelitis 
epidemic  in,  1916,  262 

New  Jersey,  malaria  in,  256 

New  Orleans,  La.,  pellagra  in,  250 

,  malaria  in,  256 

New  York  City,  poliomyelitis  epi- 
demic in,  1916,  262 

New  York  City,  prenatal  nursing  in, 
213 

Nomenclature  and  classification  of 
diseases,  9,  32 

Northern  States,  pellagra  in,  252 

,  malaria  in,  256 

Number  of  insured  wage  earners, 
estimating,  8 

Occupational  and  industrial  hazards, 
123 

Occupations,  classification  of,  9 

,  causes  of  death  in,  10 

Occupational  hazard  in  industrial  in- 
surance mortality,  2 

Occupations  of  insured  wage  earn- 
ers, 2 

Ohio  Eiver  floods,  1913,  105 

Old  age,  288 

Old  age,  cerebral  hemorrhage  mortal- 
ity in,  175 

"Old  Age,"  deathrate  from,  and 
"degenerative  diseases,"  289 

Opium  poisoning,  267 

Organic  diseases  of  the  heart — see 
Heart  disease,  65 

Osier,  William,  218 

Otitis  media,  274 

Ovaries,  cancer  of  the,  163 

Ovaritis,  288 

Padueah,  Ky.,  malaria  in,  256 

"Paralysis,"  deathrate  from,  176 

Paresis,  syphilis  in  relation  to,  237 

Pellagra,  249 

,  an  economic  problem  in  the 

South,  249,  254 

,  and  diet,  254 

,  in  relation  to  economic  and  so- 
cial conditions,  249,  254 

Pennsylvania,  malaria  in,  256 


INDEX. 


395 


Pericarditis,  274 

Peritoneum,  tuberculosis  of  the,  62 

,  cancer  of  the,  168 

"Peritonitis,"  283 

,  unsatisfactory     statement     of 

cause  of  death,  31 
-,  and  appendicitis,  233 


Pernicious  anemia,  267 

Pharyngitis,  280 

Pharynx,  diseases  of  the,  279 

Philadelphia,  Pa.,  poliomyelitis  epi- 
demic in,  1916,  263 

Physicians  helping  to  complete  data 
on  wage  earners'  mortality,  iv,  378 

Placenta  previa,  203 

Pneumokoniasis,  279 

Pneumonia,  72 

Pneumonia — lobar  and  undefined- 
see  Lobar  pneumonia,  73 

' '  Pneumonia, ' '  unsatisfactory  report 
of  cause  of  death,  77 

Poisoning,  accidental,  117 

Poisoning,  suicidal,  135 

Poisonings,  chronic,  267 

Poliomyelitis,   262 

Poplar  Bluff,  Mo.,  pellagra  in,  250 

,  malaria  in,  256 

Pregnancy  index,  for  maternal  mor- 
tality study,  200 

Pregnancy,  mortality  in,  198 

Premature  birth  (death  of  mother), 
203 

Prenatal  clinics  in  control  of  ma- 
ternal mortality,  213 

Prenatal  nursing,  in  control  of  mor- 
tality from  puerperal  albuminuria 
and  convulsions,  209 

,  in  relation  to  accidents  of 

labor,  211 

,  in  public  health  work  of  Amer- 
ican cities,  213 

Prolapse  of  the  uterus,  287 

Prostate,  cancer  of  the,  172 

,  diseases  of  the,  285 

Proteid  diet  in  pellagra,  254 

Prudential  Insurance  Company  of 
America,  23 


Public  health  administration  and 
typhoid  fever  control,  218 

Public  health  movement  and  the  dis- 
eases of  children,  178 

Public  health  statistics  of  wage 
earners,  1 

Public  health  work  in  relation  to 
tuberculosis,  59 

Puerperal  albuminuria  and  convul- 
sions, 202 

,  and  renal  and  hepatic  dis- 
eases, 210 

Puerperal  diseases,  197 

,  prevention  of,  213 

Puerperal  eclampsia,  202 

Puerperal  hemorrhage,  203 

Puerperal  hemorrhage,  lower  mortal- 
ity rate  from,  among  wage  earning 
population,  211 

Puerperal  septicemia,  201 

,  as    affecting    periods    of    the 

puerperal  state,  199 
,  and     "septicemia,"    unquali- 
fied, 266 

Puerperium,  mortality  during,  199 

Pulmonary  apoplexy,  277 

Pulmonary  congestion,  277 

Purulent  infection  and  septicemia, 
265 

Pylorus,  diseases  of  the,  281 

Pyosalpingitis,  288 

Quinsy,  280 

Race  composition  of  insured  group,  4 
Eace  factors  in  industrial  insurance 

mortality,  3 

Eacial   mortality   from    certain   dis- 
eases,  see  particular   disease. 
Kailroad  accidents  and  injuries,  107 
Ealeigh,  N.  C.,  pellagra  in,  250 

',  malaria  in,  256 

Bectum,  cancer  of  the,  168 

Registration  Area  of  United  States, 

age  composition  of  population  of,  5 

Registration  Area  of  United  States 

Mortality  by  sex  and  by  age  in 


396 


INDEX. 


United     States     and     among     in- 
sured wage  earners  compared. 
All  causes  of  death,  23 
Tuberculosis  of  the  lungs,  52 
Tuberculous  meningitis,  61 
Abdominal  tuberculosis,  64 
Organic    diseases   of   the  heart, 

68 

Lobar  pneumonia,  76 
Bronchopneumonia,  85 
Bright 's  disease,  90 
Accidents,  99 

Traumatism  by  falling,  103 
Suicides,  132 
Homicides,  144 
Cancer,  154 

of  the  stomach,  162 
of   the    female    genital    or- 
gans, 164 
of  the  breast,  167 
Cerebral   hemorrhage    and   apo- 
plexy, 176 
Measles,  180 
Scarlet  fever,  183 
Whooping   cough,   187 
Diphtheria  and  croup,  190 
Diarrhea  and  enteritis,  195 
Puerperal  diseases,  '204 
Renal  disease  in  causation  of  puer- 
peral eclampsia,  210 
Rheumatic  fever,  242 
"Rheumatism,"  242 
Richmond,  Va.,  pellagra  in,  250 
Roanoke,  Va.,  pellagra  in,  250 

Salpingitis,  287 

Sanitary  index,  typhoid  fever  as,  218 
St.  Louis,  Mo..,  malaria  in,  256 
Savannah,  Ga.,  pellagra  in,  250 

,  malaria  in,  256 

Scarlet  fever,  182 

,  immunity   of  negroes,   182 

,  in  urban  communities,  184 

Sclerosis  of  brain,  273 
Self-induced  abortion,  203 
Penility,  289 
Sequelae  of  typhoid  fever,  222 


Sepsis,  puerperal  —  see  puerperal  sep- 
ticemia,  H»l 


Septicemia,  puerperal  —  ate  Puerperal 

septicemia,  201 

Sex  composition  of  insured  group,  4 
Sex,  mortality  from  certain  diseases 

by,  see  particular  disease 
Shooting,  accidental,  121 
Simple  meningitis,  268 
Simple  peritonitis,  282 
Skin,  cancer  of  the,  170 
Social  conditions  in  relation  to  dia- 

betes mortality,  229 
Social   research   into   wage   earners' 

family  problems,  26 
Social    statistics    of    insured    wage 

earners,  1 

Social  status  and  cancer,  155 
Softening  of  the  brain,  271 
South,  pellagra  in,  249,  254 

-  ,  malaria  in,  257 
Southwest,  pellagra  in,  249 

-  ,  malaria  in,  257 
Spartanburg,  S.  C.,  pellagra  in,  250 
Spasmodic  asthma,  278 
Spasmodic  croup,  277 

Spinal  meningitis,  268 

Standard  million  of  population,  385 

Standard  of  living  in  wage  earners' 

families,  26 
Standardized,     or     corrected     death 

rates,  385 

States  included  in  this  study,  2 
Steam    railroad    accidents    and    in- 

juries, 107 
Stomach,  cancer  of  the,  160 

-  ,  diseases  of  the,  280 
—  ,  ulcer  of  the,  261 

Stouman,  Ktud,  234 

Street  car  accidents  and  injuries,  112 

"Sudden  death,"  290 

Suicide  statistics,  126 

-  ,  problem  among  wage  earners 
127 

-  ,  in  adolescence,  131 

-  ,  by  means  of  injury,  135 
poison,  135 


INDEX. 


397 


Suicide  statistics,  continued 
asphyxia,  136 
drowning,   137 
firearms,  137 

hanging  or  strangulation,  137 
Suppurative  otitis  media,  274 
Syphilis,  237 

Syphilis,  and  cirrhosis  of  the  liver, 
223 

,  as  a  cause  of  locomotor  ataxia 

and  general  paralysis   of  the  in- 
sane, 237 
— ,  certification,  237 

,  and  softening  of  the  brain,  271 

— ,  and   general   paralysis   of  the 
insane,  272 

Tabulating  machines,  10 

Technical  processes  of  compiling 
wage  earners'  mortality  statis- 
tics, 8 

Thrombosis,  276 

Tonsillitis,  280 

Tonsils,  diseases  of  the,  280 

Traumatism,  by  falling,  102 

,  by  firearms,  121 

,  by  machines,  115 

Tubal  gestation,  203 

Tuberculosis,  43 

,  disability   resulting   from,    43 

,  campaign  in  United  States,  43 

,  need  for  wage  earners'  mor- 
tality statistics  of,  43 

,  burden  upon  wage  earners' 

families,  43 

,  by  organs  or  parts,  44 

,  among  negroes,  45,  46 

,  type  curves,  51 

,  in  wage  earners'  children,  53 

,  in  rural  areas,  53 

,  effect  of  campaign  against,  57 

,  of  abdominal  organs  in  fe- 
males, and  childbearing,  168 

,  and  maternal  mortality,  197 

,  and  the  pellagra-  problem  in 

the  South,  250 

Tuberculous  meningitis,  59 

Tuberculous  peritonitis,  62 


Tuberculous  peritonitis,  and  "peri- 
tonitis," 283 

Tumor,  uterine,  286 

Types  of  tuberculosis  mortality 
curves,  51 

Typhlitis,  233 

Typhoid  fever,  218 

,  in  childhood,  220 

,  sequelae,  222 

Ulcer  of  the  stomach,  261 
Unknown  causes  of  death,  290 
Urban  life,  factor  in  wage-earners' 

mortality,  7,  25 
Uterine  tumor,  286 
Uterus,  cancer  of  the,  163 

,  diseases  of  the,  286 

,  abscess  of  the,  287 

Van  Buren,  George  H.,  iv 
Vehicles,  accidents  from  other,  113 
Venereal  disease  mortality,  237,  266 
Verifying  punched  cards,  10 
Vincent's  angina,  280 
Violent  deaths,  classification,  93 
Visiting    Nurse    Service,    Metropoli- 
tan Life  InsurUrice  Company,  ma- 
ternity nursing,  213 
Vital  statistics  of  old  age,  175 

Wage  earners'  efficiency  in  relation 
to  pellagra  and  malaria,  249,  254 

Wage  earners'  mortality  statistics, 
factors  influencing,  25 

,  uses*    of,     in     public     health 

movement,  iii 

Wage  earners'  suicide  problem,  132 

War  deaths,  jclassifieation,  93 
— ,  during  1917,  298 

Wassermann  reaction  in  locomotor 
ataxia,  271 

White  insured  wage  earners,  mortal- 
ity, 3 

Whooping  cough,  186 

,  mortality  among  negroes,  187 

Willcox,  Walter  F.,  157 

Women  in  wage  earners'  families, 
mortality  of,  3 

Work-accidents,  123 


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